Individual
MRS. BRENDA GALVIN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1248 FORT BRAGG RD, FAYETTEVILLE, NC 28305-4981
(910) 323-0334
(888) 391-5874
Mailing address
112 PARKVIEW AVE, FAYETTEVILLE, NC 28305-4908
(910) 323-0334
(888) 391-5874
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5000596
NC
363LA2200X
Adult Health Nurse Practitioner
2005003026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005003026
AMERICAN NURSES CREDENTIALING CENTER
MD
Enumeration date
10/27/2006
Last updated
06/19/2012
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