Individual
LORAINE ELIZABETH BOOZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3424 SHELBY RAY CT, CHARLESTON, SC 29414-5838
(843) 402-6834
(843) 573-9963
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
363A00000X
SC
363AM0700X
Medical Physician Assistant
1620
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1620
SOUTH CAROLINA PHYSICIAN ASSISTANT LICENSURE
SC
Enumeration date
03/13/2011
Last updated
11/01/2024
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