MR. MARK A BOOMERSHINE (NPI# 1164617122) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164617122 |
| Entity Type | Individual |
| Full Name | MR. MARK A BOOMERSHINE |
| Credential | PA |
| Practice Address |
3496 E Lake Lansing Rd Suite 100 East Lansing MI 48823-2288 |
| Practice Telephone | 5173330968 |
| Practice Fax Number | 5173334306 |
| Mailing Telephone | 5173330968 |
| Mailing Fax Number | 5173334306 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601001393 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MB1081378 | 01 |
| Street Address |
3496 E LAKE LANSING RD SUITE 100 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48823-2288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477530269 | Graham M Kelly | Family Medicine | 3496 E Lake Lansing Rd, Ste. 160, East Lansing, MI 48823-2288 | 2005-12-22 |
| 1285264366 | Kaitlin Nicolle Hurley | Counselor | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2020-01-17 |
| 1326286675 | Michael C Kennerly | Physician Assistant | 3496 E Lake Lansing Rd, Suite 100, East Lansing, MI 48823-2288 | 2009-01-24 |
| 1558508283 | Judith E Daoust | Physician Assistant | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2009-01-16 |
| 1144489659 | Robert Lacy | General Practice | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2008-06-09 |
| 1063685550 | Kimberly Garcia | Physician Assistant | 3496 E Lake Lansing Rd, Suite 160, East Lansing, MI 48823-2288 | 2008-04-07 |
| 1508036856 | Diana Marble | Nurse Practitioner | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2008-03-03 |
| 1336325356 | Mian Qayyum | Pediatrics | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2008-01-22 |
| 1750565131 | William Warren | Emergency Medicine | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2007-12-21 |
| 1710166855 | Paul Piper | General Practice | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2007-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144848631 | Joseph Santangelo | Technician | 2775 E Lansing Dr, East Lansing, MI 48823 | 2020-07-10 |
| 1679197701 | Alexandra Megan Bauer | Technician | 3839 Hunsaker Street, 121, East Lansing, MI 48823 | 2020-06-04 |
| 1689297756 | Nathan Barnhurst | Neuromusculoskeletal Medicine & OMM | 4660 Hagadorn Rd #500, East Lansing, MI 48823 | 2020-05-25 |
| 1861036006 | Rachel Amber Kelly | Registered Nurse | 221 W Lake Rd, #300, East Lansing, MI 48823 | 2019-10-31 |
| 1982176442 | Thomas Patrick Lilley | Occupational Therapist | 2900 Hannah Blvd. - Suite B102, East Lansing, MI 48823 | 2018-12-21 |
| 1386114684 | Anne Colleen Jack | Social Worker | 3100 West Road, East Lansing, MI 48823 | 2018-11-29 |
| 1346721420 | Mary Ann Malosh | Health Educator | 6265 Fenwick Ct, East Lansing, MI 48823 | 2018-08-27 |
| 1639668734 | Jennifer Lynn Box | Occupational Therapist | 2900 Hannah Blvd Ste. B102, Outpatient Rehab, East Lansing, MI 48823 | 2018-05-03 |
| 1598267288 | Wise Willow Counseling & Consulting LLC | Social Worker | 2875 Northwind Dr Ste 215, East Lansing, MI 48823 | 2018-03-08 |
| 1184142010 | Carlrianna Taylor | Technician | 2775 E Lansing Rd, E Lansing, MI 48823 | 2017-08-30 |
| Find all providers in zip 48823 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346739224 | Brian James Tsacoumangos | Physician Assistant | 2900 Hannah Blvd Ste 114, East Lansing, MI 48823-5380 | 2018-05-06 |
| 1831438852 | Helen Lynette Biery | Physician Assistant | 2025 Abbot Rd Ste 100, East Lansing, MI 48823-8573 | 2013-02-12 |
| 1053402446 | Mary Elizabeth Turner | Physician Assistant | 6110 Abbott Rd, East Lansing, MI 48823-1410 | 2006-09-28 |
| 1932188638 | Joshua David Feller | Physician Assistant | 2852 Eyde Pkwy, Ste 175, East Lansing, MI 48823-5378 | 2006-01-11 |
| 1619370160 | Jordan L Olesnavich | Physician Assistant | 830 W Lake Lansing Rd Ste 190, East Lansing, MI 48823-6371 | 2014-09-29 |
| 1508127952 | Sara M Wilchowski | Physician Assistant | 1625 Ramblewood Dr, East Lansing, MI 48823-6367 | 2012-06-01 |
| 1740565704 | Melani Ann Reaume | Physician Assistant | 411 W Lake Lansing Rd, Suite C 120, East Lansing, MI 48823-8445 | 2011-10-20 |
| 1326286675 | Michael C Kennerly | Physician Assistant | 3496 E Lake Lansing Rd, Suite 100, East Lansing, MI 48823-2288 | 2009-01-24 |
| 1558508283 | Judith E Daoust | Physician Assistant | 3496 E Lake Lansing Rd, East Lansing, MI 48823-2288 | 2009-01-16 |
| 1821233024 | Tara N Sadonis | Physician Assistant | 2852 Eyde Pkwy, Suite 175, East Lansing, MI 48823-5378 | 2008-12-03 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48823 |
Please comment or provide details below to improve the information on MR. MARK A BOOMERSHINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.