Provider Demographics
NPI:1235300542
Name:BOOKER, FRONDA SHEVA (LPN)
Entity Type:Individual
Prefix:
First Name:FRONDA
Middle Name:SHEVA
Last Name:BOOKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1112
Mailing Address - Country:US
Mailing Address - Phone:315-395-8659
Mailing Address - Fax:
Practice Address - Street 1:204 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1112
Practice Address - Country:US
Practice Address - Phone:315-395-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2272901164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse