Provider Demographics
NPI:1518360866
Name:BOOKER, MARK W (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:BOOKER
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1947
Mailing Address - Country:US
Mailing Address - Phone:330-957-0471
Mailing Address - Fax:
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7123
Practice Address - Fax:330-971-7119
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020130367500000X
OHRN311649COA1367500000X
OHRN.311649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111822Medicaid
OHPENDINGOtherMEDICARE PTAN
OHPENDINGOtherMEDICARE RAILROAD
OHPENDINGOtherANTHEM BCBS