Individual
JEREMY BOOTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
47 TOWN ST, NORWICH, CT 06360-2323
(860) 892-7042
Mailing address
47 TOWN ST, NORWICH, CT 06360-2323
(860) 892-7042
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5947
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008056298
—
CT
Enumeration date
10/27/2014
Last updated
01/20/2015
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