Basic Information
| Provider Information | |||||||||
| NPI: | 1922268978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOSE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DELORES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.P.H. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 123 HENDERSONVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288032868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282574730 | ||||||||
| FaxNumber: | 8282322942 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 HENDERSONVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288032868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282574730 | ||||||||
| FaxNumber: | 8282322942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35095053 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101258063 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | FB1942083 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.