Provider Demographics
NPI:1477003192
Name:BOOTH, ANGELA LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LEE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3164
Mailing Address - Country:US
Mailing Address - Phone:307-234-6765
Mailing Address - Fax:
Practice Address - Street 1:3632 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3164
Practice Address - Country:US
Practice Address - Phone:307-234-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22031.1556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily