Provider Demographics
NPI:1225319494
Name:BOOTH, LAUREL M (DNP, ACNP, CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:M
Last Name:BOOTH
Suffix:
Gender:F
Credentials:DNP, ACNP, CRNA
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 550, 2 CATHARINE ST
Mailing Address - Street 2:PARK SLOPE ANESTHESIA ASSOCIATES, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-868-8416
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:506 6TH STREET
Practice Address - Street 2:NY METHODIST HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589175163W00000X, 367500000X
NYF432646-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care