Provider Demographics
NPI:1871933929
Name:BOOZE, KATRINA M (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:M
Last Name:BOOZE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2620
Mailing Address - Country:US
Mailing Address - Phone:937-328-5300
Mailing Address - Fax:
Practice Address - Street 1:2624 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2620
Practice Address - Country:US
Practice Address - Phone:937-328-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN353747133N00000X
OHAPRN.CNP.0037800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist