Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 106158 | MO |
NPI | 1013010370 |
---|---|
Provider Name | Michelle Adriana Boice |
First Address | Lamar, MO 64759-8105 |
Second Address | Lamar, MO 64759-8105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 14/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E97484 | (02) |