Provider Demographics
NPI:1487481958
Name:BOOTON, TARA JAIMA
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:JAIMA
Last Name:BOOTON
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 1:456 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1207
Mailing Address - Country:US
Mailing Address - Phone:402-276-6385
Mailing Address - Fax:
Practice Address - Street 1:824 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1370
Practice Address - Country:US
Practice Address - Phone:402-873-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider