Healthcare Provider Details

I. General information

NPI: 1437522307
Provider Name (Legal Business Name): LAJUAN BETHUNE BOOKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 FULTON ST
BROOKLYN NY
11208-1907
US

IV. Provider business mailing address

24 KNIGHTS CIR
NEWBURGH NY
12550-2422
US

V. Phone/Fax

Practice location:
  • Phone: 833-244-7111
  • Fax:
Mailing address:
  • Phone: 917-273-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339938
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: