| Doctor Name: | NELLIE LUCILLE BOONE |
| NPI Number: | 1134317803 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | TA10005278 |
| Business Practice Address: | 500 E Webster Ave Chewelah, WA - 991099523 |
| Business Phone Number: | 5099358211 |
| Business Fax Number: | 5099355257 |
| Mailing Address: | 500 E Webster Ave, CHEWELAH |
| State: | WA |
| Postal Code: | 991099523 |
| Phone Number: | 5099358211 |
| Fax Number: | 5099355257 |
| NPI Enumeration Date: | 10/09/2007 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | TA10005278 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |