Provider Demographics
NPI:1457637357
Name:BOOKER, VARIS
Entity Type:Individual
Prefix:MRS
First Name:VARIS
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WALLINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1918
Mailing Address - Country:US
Mailing Address - Phone:216-780-2406
Mailing Address - Fax:216-382-2077
Practice Address - Street 1:3810 WALLINGFORD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-1918
Practice Address - Country:US
Practice Address - Phone:216-780-2406
Practice Address - Fax:216-382-2077
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188975343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)