Provider Demographics
NPI:1508190471
Name:BOOKER, MARQUITA
Entity Type:Individual
Prefix:
First Name:MARQUITA
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 1:4905 NORTHCUTT PL
Mailing Address - Street 2:7
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3864
Mailing Address - Country:US
Mailing Address - Phone:937-380-1129
Mailing Address - Fax:
Practice Address - Street 1:4905 NORTHCUTT PL
Practice Address - Street 2:7
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3864
Practice Address - Country:US
Practice Address - Phone:937-380-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400815061008376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide