Provider Demographics
NPI:1316548977
Name:BOONE, SAMANTHA DAWN
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:DAWN
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 1:45 C AND B SALVAGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-8000
Mailing Address - Country:US
Mailing Address - Phone:304-237-8905
Mailing Address - Fax:
Practice Address - Street 1:45 C AND B SALVAGE RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-8000
Practice Address - Country:US
Practice Address - Phone:304-237-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant