Provider Demographics
NPI:1033388665
Name:BOOZER, CAROLYN ANN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:BOOZER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COUNTY ROAD 266
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7627
Mailing Address - Country:US
Mailing Address - Phone:334-255-7033
Mailing Address - Fax:334-255-7224
Practice Address - Street 1:BUILDING 301 ANDREWS ST
Practice Address - Street 2:
Practice Address - City:FT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse