Provider Demographics
NPI:1548133747
Name:BOOTHE, PAULINE ANGELLA
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:ANGELLA
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:ANGELLA
Other - Last Name:BOOTHE-JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 MANHASSET AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3710
Mailing Address - Country:US
Mailing Address - Phone:917-488-3938
Mailing Address - Fax:
Practice Address - Street 1:16 MANHASSET AVE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3710
Practice Address - Country:US
Practice Address - Phone:917-488-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN08541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse