Individual
MRS. JACQULYNE S BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
995 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5588
(812) 353-3060
(812) 353-3070
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-3087
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001863
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28085357A
INDIANA RN
IN
01
—
71001863
INDIANA NURSE PRACTITIONE
IN
Enumeration date
05/20/2006
Last updated
12/02/2020
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