Provider Demographics
NPI:1215074620
Name:BOONE, MARTHA SUE (LVN)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:SUE
Last Name:BOONE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-0529
Mailing Address - Country:US
Mailing Address - Phone:361-935-6232
Mailing Address - Fax:361-578-3366
Practice Address - Street 1:800 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3718
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:361-937-9421
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163887164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163887OtherL.V.N. LICENSE NUMBER