Provider Demographics
NPI:1235470147
Name:BOOKER, THERESA RUGALLA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:RUGALLA
Last Name:BOOKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:RUGALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:8518 79TH DIVISION BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-1507
Mailing Address - Country:US
Mailing Address - Phone:717-512-8765
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012500363LA2100X
MDR184354363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care