Provider Demographics
NPI:1518376615
Name:BOONE, DEEDRA DANETTE (RN)
Entity Type:Individual
Prefix:
First Name:DEEDRA
Middle Name:DANETTE
Last Name:BOONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MCCARVER AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3230
Mailing Address - Country:US
Mailing Address - Phone:541-530-1108
Mailing Address - Fax:
Practice Address - Street 1:232 NW 6TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3609
Practice Address - Country:US
Practice Address - Phone:503-294-1681
Practice Address - Fax:503-294-4321
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242550RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse