Marilee Green Bomar, MSN

Primary specialty

Gerontology Clinical Nurse SpecialistTaxonomy code 364SG0600X

License

128845 Issued in MO

Practice address

551 E Southampton Dr
Columbia, MO 65201-4236

Phone

(573) 884-7733

Fax

(573) 882-6228

NPI assigned

Jun 1, 2006

Last updated

May 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Marilee Sue Green Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Master of Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1013954601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843966",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641843966",
            "telephone_number": "573-884-3300",
            "fax_number": "573-884-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 E SOUTHAMPTON DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652014236",
            "telephone_number": "573-884-7733",
            "fax_number": "573-882-6228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMAR",
        "first_name": "MARILEE",
        "middle_name": "GREEN",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "128845",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "MO",
            "license": "128845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420750200",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILEE",
            "last_name": "GREEN",
            "middle_name": "SUE",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Shane Bolina, MD
• Melody Ann Boling, LCSW
• Olivia Louise Bolles, MD
• Debra Jean Bolton, PT
• Meghan Boltz, RPH
• Charles P. Bondurant, M.D.
• Holly H Bondurant, M.D.
• Linda Bonebrake, LPC
• Michael G Bonen
• Roger D Bonham, M.D.

• Gerontology Clinical Nurse Specialist in Columbia, MO
• Providers in Columbia, MO by specialty
• Gerontology Clinical Nurse Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.