Provider Demographics
NPI:1770881823
Name:BOOKER, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BOOKER
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 1:240 MONTROSE AVE
Mailing Address - Street 2:#4
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2931
Mailing Address - Country:US
Mailing Address - Phone:716-885-6885
Mailing Address - Fax:
Practice Address - Street 1:240 MONTROSE AVE
Practice Address - Street 2:#4
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223-2931
Practice Address - Country:US
Practice Address - Phone:716-885-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266243-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse