Healthcare Provider Details

I. General information

NPI: 1629981915
Provider Name (Legal Business Name): WILLIAM BOOTH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 TAYLOR DR
SPRINGFIELD VT
05156-2216
US

IV. Provider business mailing address

28 TAYLOR DR
SPRINGFIELD VT
05156-2216
US

V. Phone/Fax

Practice location:
  • Phone: 720-602-6515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0151999
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: