Healthcare Provider Details

I. General information

NPI: 1740054881
Provider Name (Legal Business Name): NASHAWN TIERRA BOOKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 NAHANT RD
BALTIMORE MD
21206-3134
US

IV. Provider business mailing address

6027 NAHANT RD
BALTIMORE MD
21206-3134
US

V. Phone/Fax

Practice location:
  • Phone: 443-468-7346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR208365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: