Provider Demographics
NPI:1881862258
Name:BOMA, CAMERICA S (CRNA)
Entity Type:Individual
Prefix:
First Name:CAMERICA
Middle Name:S
Last Name:BOMA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790058
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0058
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:45 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 207
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4425
Practice Address - Country:US
Practice Address - Phone:301-694-3400
Practice Address - Fax:301-694-3620
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBC1CHOtherCAREFIRST BCBS
MD4191765 00Medicaid
DCS417 0025OtherCAREFIRST BCBS
MDP00745067OtherMEDICARE RAILROAD
MD135536Y2MMedicare PIN