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Individual

MAQUIA MASSIRIE HALL-BOOTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
3129 WESTCHESTER DR, CLARKSVILLE, TN 37043-3804
(708) 359-5472
Mailing address
3129 WESTCHESTER DR, CLARKSVILLE, TN 37043-3804
(708) 359-5472

Taxonomy

Speciality
Code
Description
License number
State
385HR2065X
Child Physical Disabilities Respite Care
Primary
0219037
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LPN0000091074
NURSING LICENSE
TN
Enumeration date
02/22/2019
Last updated
02/22/2019
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