Provider Demographics
NPI:1932169158
Name:BOOTH, JUDITH A (NNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BOOTH
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE ELLIOT WAY
Mailing Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-663-2692
Mailing Address - Fax:602-663-3982
Practice Address - Street 1:ONE ELLIOT WAY
Practice Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-663-2692
Practice Address - Fax:602-663-3982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH034647-23-10363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30341253Medicaid
Q11761Medicare UPIN
NHNP4497Medicare PIN