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General NPI Number Information
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NPI Number | 1003459132
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Entity Type | Individual
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Provider Name | MARY E BOOTH DNP
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Gender | Female
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1 SAINT JOSEPH DR
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City | CENTERVILLE
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State | IA
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Zip | 52544-9017
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Country | US
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Telephone | 641-856-8684
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Fax | 641-548-5233
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Provider Business Mailing Address
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Address Line | 1 SAINT JOSEPH DR
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City | CENTERVILLE
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State | IA
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Zip | 52544-9017
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Country | US
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Telephone | 641-437-3000
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Fax | 641-437-3403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2019031435
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A180897
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License Number State | IA
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