Provider Demographics
NPI:1861802977
Name:BOONE, LAURA (RN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 PAGELAND HWY
Mailing Address - Street 2:PO BOX 817
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-7606
Mailing Address - Country:US
Mailing Address - Phone:803-286-8441
Mailing Address - Fax:803-286-1258
Practice Address - Street 1:1833 PAGELAND HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7606
Practice Address - Country:US
Practice Address - Phone:803-286-8441
Practice Address - Fax:803-286-1258
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC43806OtherSC NURSING LICENSE