Provider Demographics
NPI:1871050104
Name:HALL-BOOTH, MAQUIA MASSIRIE (LPN)
Entity type:Individual
Prefix:
First Name:MAQUIA
Middle Name:MASSIRIE
Last Name:HALL-BOOTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3804
Mailing Address - Country:US
Mailing Address - Phone:708-359-5472
Mailing Address - Fax:
Practice Address - Street 1:3129 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-3804
Practice Address - Country:US
Practice Address - Phone:708-359-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0219037385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPN0000091074OtherNURSING LICENSE