Individual
AMY JEAN BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3152 PORT SHELDON ST, SUITE C, HUDSONVILLE, MI 49426-9297
(616) 669-9238
(616) 669-8296
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003186
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08-5-70-1100-0
BCBS
MI
01
—
M74460743
MEDICARE PTAN
MI
Enumeration date
07/26/2005
Last updated
02/26/2021
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