MEDICARE: CRAIG STEVEN BOSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1003009267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG STEVEN BOSLEY

Provider Business Mailing Address
First Line	:	10 OROTE POINT RD
Second Line	:
City	:	SANTA RITA
State	:	GU
Zip	:	96915-1130
Country	:	US
Telephone Number	:	671-564-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 OROTE POINT RD
Second Line	:
City	:	SANTA RITA
State	:	GU
Zip	:	96915-1130
Country	:	US
Telephone Number	:	671-564-9098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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Directions to “ CRAIG STEVEN BOSLEY ” Practice Location

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