Provider Demographics
NPI:1548698178
Name:BOOYSE, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:BOOYSE
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 1:2401 BENTZEN CIR APT A36
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3206
Mailing Address - Country:US
Mailing Address - Phone:907-953-2349
Mailing Address - Fax:
Practice Address - Street 1:2401 BENTZEN CIR APT A36
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3206
Practice Address - Country:US
Practice Address - Phone:907-953-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse