Provider Demographics
NPI:1174095269
Name:BOONE, JOMESA DE'LICE
Entity type:Individual
Prefix:
First Name:JOMESA
Middle Name:DE'LICE
Last Name:BOONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 HICKORY RIDGE RD APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4631
Mailing Address - Country:US
Mailing Address - Phone:410-689-5876
Mailing Address - Fax:
Practice Address - Street 1:10411 HICKORY RIDGE RD APT B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4631
Practice Address - Country:US
Practice Address - Phone:443-518-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT00164113747P1801X
MDRSA-02344374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant