Provider Demographics
NPI:1982391256
Name:BOON, TRACI (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:BOON
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 1:3730 MONA KAI BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3741
Mailing Address - Country:US
Mailing Address - Phone:616-560-7088
Mailing Address - Fax:
Practice Address - Street 1:3730 MONA KAI BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3741
Practice Address - Country:US
Practice Address - Phone:616-560-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704180882163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse