Provider Demographics
NPI:1538337597
Name:BOOTH, LINDA R (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:BOOTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-1218
Mailing Address - Country:US
Mailing Address - Phone:078-425-4341
Mailing Address - Fax:
Practice Address - Street 1:333 SOUTH STREET
Practice Address - Street 2:UMASS CORRECTIONAL HEALTH
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:078-425-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163346363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0318043Medicaid
MA553787Medicare UPIN