Doctor Name: | TRACIE F BONER |
NPI Number: | 1679709554 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 52119 |
Business Practice Address: | 122 Center St Clay, WV - 250437046 |
Business Phone Number: | 3045877301 |
Business Fax Number: | 3045872464 |
Mailing Address: | 122 Center St, CLAY |
State: | WV |
Postal Code: | 250437046 |
Phone Number: | 3045877301 |
Fax Number: | 3045872464 |
NPI Enumeration Date: | 06/05/2009 |
NPI Last Update Date: | 09/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 52119 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |