Provider Demographics
NPI:1417208513
Name:BOOTHBY, ANDREA CHRISTINE (CNIM)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10055 BELKNAP RD
Mailing Address - Street 2:#114
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1102
Mailing Address - Country:US
Mailing Address - Phone:281-495-5966
Mailing Address - Fax:281-495-5799
Practice Address - Street 1:10055 BELKNAP RD
Practice Address - Street 2:#114
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1102
Practice Address - Country:US
Practice Address - Phone:281-495-5966
Practice Address - Fax:281-495-5799
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX880246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic