Most Relevant Information
Provider Data
| NPI Number: | 1003367996 |
| Provider Name: | STEPHANIE BOOTH |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/17/2016 |
| Last Updated: | 10/17/2016 |
Provider Practice Location
5301 DUBLIN AVE APT 706
MIDLAND
MI
486403133
Practice Location Phone/Fax
| Phone: | 9897502767 |
| Fax: |
Provider Mailing Location
5301 DUBLIN AVE APT 706
MIDLAND
MI
486403133
Provider Mailing Phone/Fax
| Phone: | 9897502767 |
| Fax: |