MARIE VALE BOOMER (NPI# 1164621009) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164621009 |
| Entity Type | Individual |
| Full Name | MARIE VALE BOOMER |
| Credential | PA-C |
| Practice Address |
28455 Haggerty Rd Ste 200 Novi MI 48377-2982 |
| Mailing Address |
6676 Solutions Ctr Chicago IL 60677-6006 |
| Practice Telephone | 2488933200 |
| Practice Fax Number | 2488932950 |
| Mailing Telephone | 2488933200 |
| Mailing Fax Number | 2488932951 |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2015-12-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601001569 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
28455 HAGGERTY RD STE 200 |
| City | NOVI |
| State | MI |
| Zip Code | 48377-2982 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437147964 | Stephen Craig Hyman | Physical Medicine & Rehabilitation | 28455 Haggerty Rd, Suite 200, Novi, MI 48377-2982 | 2005-10-10 |
| 1992206924 | Julie Ebel | Physical Therapist | 28455 Haggerty Rd, Novi, MI 48377-2982 | 2018-02-26 |
| 1508367418 | Timothy Lawrence Fifer | Physical Therapist | 28455 Haggerty Rd, Novi, MI 48377-2982 | 2018-02-26 |
| 1578921441 | Jill Gettle | Dietitian, Registered | 28455 Haggerty Rd, Suite 102, Novi, MI 48377-2982 | 2016-02-05 |
| 1821402678 | Richard Declercq | Nurse Practitioner | 28455 Haggerty Rd, Suite 200, Novi, MI 48377-2982 | 2014-06-19 |
| 1568889004 | Lorna Broom | Nurse Practitioner | 28455 Haggerty Rd, Ste 200, Novi, MI 48377-2982 | 2014-03-22 |
| 1043636772 | Susan Musto | Nurse Practitioner | 28455 Haggerty Rd, Suite 200, Novi, MI 48377-2982 | 2014-03-05 |
| 1497048193 | Lindsey Alexandra Rossman | Physical Medicine & Rehabilitation | 28455 Haggerty Rd, Ste 200, Novi, MI 48377-2982 | 2011-05-27 |
| 1306140819 | Danielle M Bessesen | Nurse Practitioner | 28455 Haggerty Rd, Ste 200, Novi, MI 48377-2982 | 2010-12-28 |
| 1598075616 | Bruce Frederick Wilkens | Physician Assistant | 28455 Haggerty Rd, Ste 200, Novi, MI 48377-2982 | 2010-10-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679075758 | Andrea Campbell | Nurse Practitioner | 44000 W 12 Mile Rd Ste 113, Novi, MI 48377 | 2018-03-05 |
| 1811421928 | Michigan Eye and Contact Lens Pllc | Optometrist | 42081 14 Mile Road, Novi, MI 48377 | 2017-04-14 |
| 1336695691 | Deanna Lynne Klein | Speech-Language Pathologist | 44140 Fox Run Road, Novi, MI 48377 | 2016-08-28 |
| 1871940973 | Jaime Durante | Nurse Practitioner | 44070 W. 12 Mile Rd, Suite 100, Novi, MI 48377 | 2016-05-18 |
| 1508225624 | Trilogy Healthcare of Oakland II, LLC | Skilled Nursing Facility | 41795 W 12 Mile Road, Novi, MI 48377 | 2016-02-17 |
| 1144688854 | Hussein Azzam | Allergy & Immunology | 46325 W 12 Mile Rd Ste 215, Novi, MI 48377 | 2016-02-09 |
| 1598120164 | Nova Counseling Services Inc. | Counselor | 41650 Clemens Circle, Novi, MI 48377 | 2015-12-23 |
| 1891174587 | Reem Mariam Mansour | Occupational Therapist | 44125 West 12 Mile Rd E-123, Novi, MI 48377 | 2015-05-27 |
| 1154747095 | Ali Hassan Ismail | Dentist | 41920 Wolfe Pass, Novi, MI 48377 | 2014-03-17 |
| 1558703876 | Twelve Oaks Orthodontics Pllc | Dentist | 44110 W 12 Mile Rd, Suite 100, Novi, MI 48377 | 2013-07-29 |
| Find all providers in zip 48377 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013535343 | Maria Pavia | Physician Assistant | 41302 Scarborough Ln, Novi, MI 48375-2893 | 2020-07-13 |
| 1669634499 | Rema Palissery Menon | Physician Assistant | 41267 Scarborough Ln, Novi, MI 48375-2892 | 2008-07-02 |
| 1598325177 | Rachael Courter | Physician Assistant | 39465 W 14 Mile Rd, Novi, MI 48377-1600 | 2019-06-17 |
| 1609344217 | Sarah Alm | Physician Assistant | 39475 Lewis Dr Ste 200, Novi, MI 48377 | 2018-11-13 |
| 1003393190 | Devyn Porath | Physician Assistant | 39555 W 10 Mile Rd Ste 302, Novi, MI 48375-2950 | 2018-07-23 |
| 1710492590 | Kristie K Greear | Physician Assistant | 47601 Grand River Ave, Novi, MI 48374-1233 | 2017-12-03 |
| 1124547567 | Ariel Dews | Physician Assistant | 47601 Grand River Ave, Novi, MI 48374-1233 | 2017-09-18 |
| 1952831596 | Halee Doyle | Physician Assistant | 47601 Grand River Ave, Novi, MI 48374-1233 | 2017-06-15 |
| 1649630625 | Kaitlin Mary Henkel | Physician Assistant | 39475 Lewis Dr, Suite 130, Novi, MI 48377-2981 | 2016-03-03 |
| 1801278361 | Karen A Marinica | Physician Assistant | 47601 Grand River Ave, Novi, MI 48374-1233 | 2015-06-22 |
| Find all providers in NOVI | ||||
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| 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.