Most Relevant Information
Provider Data
| NPI Number: | 1003012352 |
| Provider Name: | CARRIE JEAN BOOTS N.P. |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2200X |
| Specialty: | Nurse Practitioner |
| License Number: | 71002416A |
Most Important Dates
| Enumeration Date: | 06/25/2007 |
| Last Updated: | 07/23/2020 |
Provider Practice Location
7910 W JEFFERSON BLVD STE 108
FORT WAYNE
IN
468044159
Practice Location Phone/Fax
| Phone: | 2604848830 |
| Fax: | 2604831911 |
Provider Mailing Location
6610 MUTUAL DR
FORT WAYNE
IN
468254236
Provider Mailing Phone/Fax
| Phone: | 2604848830 |
| Fax: | 2604831911 |