Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0216X | Pediatric Rheumatologist | A61747 | CA |
N | 2080P0216X | Pediatric Rheumatologist | MD2014-0891 | NM |
Y | 2080P0216X | Pediatric Rheumatologist | MD60628779 | WA |
NPI | 1174613244 |
---|---|
Provider Name | Sheryl J Boon |
First Address | Tacoma, WA 98405-3720 |
Second Address | Tacoma, WA 98405-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 06/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A617470 | (05) | CA |
H78374 | (02) | CA |