Provider Demographics
NPI:1285990119
Name:BOOTHE, ROSE M
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 MORAN PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4437
Mailing Address - Country:US
Mailing Address - Phone:314-397-0905
Mailing Address - Fax:314-222-3394
Practice Address - Street 1:8650 MORAN PL ACE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4437
Practice Address - Country:US
Practice Address - Phone:314-397-0905
Practice Address - Fax:314-222-3394
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011515473747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant