Provider Demographics
NPI:1053634899
Name:DUNFORD-BOOTHE, ROSALINA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ROSALINA
Middle Name:
Last Name:DUNFORD-BOOTHE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-0817
Mailing Address - Country:US
Mailing Address - Phone:304-250-4521
Mailing Address - Fax:304-250-7014
Practice Address - Street 1:269 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3139
Practice Address - Country:US
Practice Address - Phone:304-250-4521
Practice Address - Fax:304-250-7014
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31199163W00000X, 163WC1600X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development