Healthcare Provider Details

I. General information

NPI: 1437283199
Provider Name (Legal Business Name): DANIELLE BOOTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAY VIEW AVE
RIVERSIDE RI
02915-4955
US

IV. Provider business mailing address

26 SOMERSET AVE
RIVERSIDE RI
02915-2433
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-3706
  • Fax:
Mailing address:
  • Phone: 401-480-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN43781
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN05321
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: