Provider Demographics
NPI:1801545405
Name:BOOKER, WARRIN TRAVEAL
Entity type:Individual
Prefix:
First Name:WARRIN
Middle Name:TRAVEAL
Last Name:BOOKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 32ND ST APT 612
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4073
Mailing Address - Country:US
Mailing Address - Phone:864-918-7678
Mailing Address - Fax:
Practice Address - Street 1:501 E 32ND ST APT 612
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4073
Practice Address - Country:US
Practice Address - Phone:864-918-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program