Provider Demographics
NPI:1346756111
Name:BOONE, NAKIA A (STNA)
Entity Type:Individual
Prefix:
First Name:NAKIA
Middle Name:A
Last Name:BOONE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9704 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2154
Mailing Address - Country:US
Mailing Address - Phone:216-583-6627
Mailing Address - Fax:
Practice Address - Street 1:9704 YALE AVE # 3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2154
Practice Address - Country:US
Practice Address - Phone:216-583-6627
Practice Address - Fax:216-583-6627
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400943440709376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide