Individual
ANGELA D BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2105 W GENESEE ST, SYRACUSE, NY 13219-1698
(315) 468-3239
(315) 468-2917
Mailing address
436 KIRK AVE, SYRACUSE, NY 13205-1234
(315) 454-2459
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
267712-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
267712-1
LPN LICENSE
NY
Enumeration date
07/14/2010
Last updated
07/14/2010
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