Provider Demographics
NPI:1821403213
Name:BOOKER, DENNIS (LPN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BOOKER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 WAITS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9576
Mailing Address - Country:US
Mailing Address - Phone:937-444-1432
Mailing Address - Fax:
Practice Address - Street 1:3709 WAITS RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9576
Practice Address - Country:US
Practice Address - Phone:937-444-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.125792-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse