Provider Demographics
NPI:1780956201
Name:BOOTH, ISABELLE K
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:K
Last Name:BOOTH
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 1:8 BERING STREET
Mailing Address - Street 2:
Mailing Address - City:KIVALINA
Mailing Address - State:AK
Mailing Address - Zip Code:99750-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 BERING STREET
Practice Address - Street 2:
Practice Address - City:KIVALINA
Practice Address - State:AK
Practice Address - Zip Code:99750-0008
Practice Address - Country:US
Practice Address - Phone:907-645-2141
Practice Address - Fax:907-645-2181
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker