Organization
LAURA H. BOMAN, CRNP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE L CHESNUTT (BOOKKEEPER)
(334) 281-6363
Entity
Organization
Contact information
Practice address
2023 NORMANDIE DR, MONTGOMERY, AL 36111-2711
(334) 284-4253
Mailing address
PO BOX 201325, MONTGOMERY, AL 36120-1325
(334) 284-4253
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1-041326
AL
363LF0000X
Family Nurse Practitioner
Primary
201793
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000969
—
NC
05
—
B0051506240
—
AL
Enumeration date
05/11/2007
Last updated
12/18/2007
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