Provider Demographics
NPI:1972297703
Name:BOOMER, JOANN LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:LYNN
Last Name:BOOMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8782 CORDIAL RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2136
Mailing Address - Country:US
Mailing Address - Phone:161-930-6822
Mailing Address - Fax:
Practice Address - Street 1:8782 CORDIAL RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2136
Practice Address - Country:US
Practice Address - Phone:619-306-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA781043163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163W00000XNursing Service ProvidersRegistered Nurse