Provider Demographics
NPI:1174666713
Name:BOOTH, PAULA SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUZANNE
Last Name:BOOTH
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 1:8341 HENDRICKSON RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8933
Mailing Address - Country:US
Mailing Address - Phone:937-414-6397
Mailing Address - Fax:
Practice Address - Street 1:8341 HENDRICKSON RD APT 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-8933
Practice Address - Country:US
Practice Address - Phone:937-414-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN304034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619750Medicaid