Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 112218 | NE |
NPI | 1063932028 |
---|---|
Provider Name | Laura Beth Boon |
First Address | Omaha, NE 68198-9500 |
Second Address | Omaha, NE 68198-9500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 11/12/2019 |