Provider Demographics
NPI:1902220734
Name:BOOHER, CONNIE JO
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JO
Last Name:BOOHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:JO
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5682 MEADOW VIEW CT
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9811
Mailing Address - Country:US
Mailing Address - Phone:425-879-0879
Mailing Address - Fax:360-707-4804
Practice Address - Street 1:5682 MEADOW VIEW CT
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9811
Practice Address - Country:US
Practice Address - Phone:425-879-0879
Practice Address - Fax:360-707-4804
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00074845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse