Provider Demographics
NPI:1891419719
Name:BOONE, MEGAN JULIANA
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JULIANA
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 1:824 CENTRAL AVE APT 1206
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1631
Mailing Address - Country:US
Mailing Address - Phone:240-872-8795
Mailing Address - Fax:
Practice Address - Street 1:824 CENTRAL AVE APT 1206
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1631
Practice Address - Country:US
Practice Address - Phone:240-872-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant