Provider Demographics
NPI:1184000879
Name:BOOTH, OLIVIA A (APRN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:BOOTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:A
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 SPIT BROOK RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5614
Mailing Address - Country:US
Mailing Address - Phone:603-821-0008
Mailing Address - Fax:603-554-8617
Practice Address - Street 1:61 SPIT BROOK RD STE 202
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5614
Practice Address - Country:US
Practice Address - Phone:603-821-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH058167-23363LF0000X, 363LP0808X
MARN2269058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily