Provider Demographics
NPI:1437522307
Name:BETHUNE BOOKER, LAJUAN (FNP)
Entity Type:Individual
Prefix:
First Name:LAJUAN
Middle Name:
Last Name:BETHUNE BOOKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 KNIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2422
Mailing Address - Country:US
Mailing Address - Phone:917-273-7686
Mailing Address - Fax:
Practice Address - Street 1:3215 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1907
Practice Address - Country:US
Practice Address - Phone:833-244-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339938363LF0000X
NYF339938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily