Provider Demographics
NPI:1366093056
Name:BOONE, OLIVIA CHRISTINA (RN)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:CHRISTINA
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 1:400 E RANDOLPH ST APT 3616
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7343
Mailing Address - Country:US
Mailing Address - Phone:612-600-5382
Mailing Address - Fax:
Practice Address - Street 1:400 E RANDOLPH ST APT 3616
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7343
Practice Address - Country:US
Practice Address - Phone:612-600-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041447607163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041447607OtherNURSE LICENSE