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NPI Code Detail

MEDICARE: MARY LYNN BOOKER NP

MEDICARE: MARY LYNN BOOKER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024138177VA

General Provider Information

NPI Number : 1972581262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LYNN BOOKER NP
Provider Business Mailing Address
First Line : 11814 KING WILLIAM RD
Second Line : PO BOX 213
City : AYLETT
State : VA
Zip : 23009-4103
Country : US
Telephone Number : 804-769-3022
Fax Number : 804-769-1253
Provider Business Practice Location Address
First Line : 11814 KING WILLIAM RD
Second Line :
City : AYLETT
State : VA
Zip : 23009-4103
Country : US
Telephone Number : 804-769-3022
Fax Number : 804-769-1253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 10/14/2014

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