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General NPI Number Information
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NPI Number | 1538337597
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Entity Type | Individual
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Provider Name | LINDA R BOOTH NP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 333 SOUTH STREET UMASS CORRECTIONAL HEALTH
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City | SHREWSBURY
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State | MA
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Zip | 01545
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Country | US
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Telephone | 78-425-4341
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1218
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City | SHIRLEY
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State | MA
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Zip | 01464-1218
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Country | US
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Telephone | 78-425-4341
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 163346
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License Number State | MA
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