Provider Demographics
NPI:1164055158
Name:BOONE, TAJUANIA SHANETTE
Entity Type:Individual
Prefix:
First Name:TAJUANIA
Middle Name:SHANETTE
Last Name:BOONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 OAKCREST ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-4730
Mailing Address - Country:US
Mailing Address - Phone:318-426-0469
Mailing Address - Fax:
Practice Address - Street 1:1143 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6605
Practice Address - Country:US
Practice Address - Phone:318-426-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide