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General NPI Number Information
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NPI Number | 1538902911
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Entity Type | Individual
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Provider Name | NKIRUKA E BOOTH CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2024
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Last Update Date | 01/26/2025
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Provider Practice Location Address
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Address Line | 3300A CENTENNIAL LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-3600
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Country | US
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Telephone | 301-792-5104
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Fax |
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Provider Business Mailing Address
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Address Line | 3300A CENTENNIAL LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-3600
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Country | US
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Telephone | 866-389-2727
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R224045
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License Number State | MD
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