Provider Demographics
NPI:1407450141
Name:BOOTHBY, JANI LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:JANI
Middle Name:LYNN
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JANI
Other - Middle Name:LYNN
Other - Last Name:SOLKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5228 CREST DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-7249
Mailing Address - Country:US
Mailing Address - Phone:712-229-3622
Mailing Address - Fax:
Practice Address - Street 1:715 W MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1564
Practice Address - Country:US
Practice Address - Phone:712-229-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily