Individual
LAUREN ASHLEY BOOTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.005325
IL
363A00000X
Physician Assistant
Primary
5601007226
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528465937
—
MI
Enumeration date
12/01/2014
Last updated
10/04/2018
Update your record
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