Healthcare Provider Details

I. General information

NPI: 1972662724
Provider Name (Legal Business Name): ELIZABETH ANNE BOOT BSN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITERIVER DR. 200 W. HOSPITAL DR.
WHITERIVER AZ
85941
US

IV. Provider business mailing address

PO BOX 860 200 W. HOSPITAL DR.
WHITERIVER AZ
85941-0860
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax:
Mailing address:
  • Phone: 928-338-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01537
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN086776
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: