1396380317 NPI number — SYDNEY LORRAINE BOOTHE APRN-BC, DNP

Table of content: SYDNEY LORRAINE BOOTHE APRN-BC, DNP (NPI 1396380317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396380317 NPI number — SYDNEY LORRAINE BOOTHE APRN-BC, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOTHE
Provider First Name:
SYDNEY
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUTTON
Provider Other First Name:
SYDNEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396380317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 S CAROLYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOCTAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73020-6929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-810-7546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 HEALTHPLEX PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-9749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-515-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0005X , with the licence number:  109343 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: 0109343 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)