Basic Information
| Provider Information | |||||||||
| NPI: | 1518599307 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BOOMS | ||||||||
| FirstName: | ERIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 E MOORESTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496519284 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9249 W LAKE CITY RD | ||||||||
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| City: | HOUGHTON LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486299602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894225122 | ||||||||
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| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4702496673 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.