Provider Demographics
NPI:1881677615
Name:BOOTH, ANITA W (CRNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:W
Last Name:BOOTH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:100 SHENANGO AVENUE
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-0716
Mailing Address - Country:US
Mailing Address - Phone:724-342-6900
Mailing Address - Fax:724-342-6905
Practice Address - Street 1:2000 GREEN ST BLDG B
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1369
Practice Address - Country:US
Practice Address - Phone:724-342-6900
Practice Address - Fax:724-342-6905
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-07-21
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN517085L163W00000X
PAUP006925B363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP37932Medicare UPIN
PA050223RN0Medicare PIN