Healthcare Provider Details

I. General information

NPI: 1922650936
Provider Name (Legal Business Name): JENNIFER Q BOOTH CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 E FARMERSVILLE RD
EPHRATA PA
17522-8510
US

IV. Provider business mailing address

94-108 LEOWAENA ST
WAIPAHU HI
96797-2223
US

V. Phone/Fax

Practice location:
  • Phone: 717-847-7577
  • Fax: 717-842-7912
Mailing address:
  • Phone: 833-428-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number133490
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19060012
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: