MEDICARE: MR. JOHN D BOSSE MS, RD, NSCA-CPT

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	133V00000X	Registered Dietitian	ND 5933	FL

General Provider Information

NPI Number	:	1528346046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN D BOSSE MS, RD, NSCA-CPT

Provider Business Mailing Address
First Line	:	18 ORLEANS ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-4334
Country	:	US
Telephone Number	:	207-689-8464
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 ORLEANS ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-4334
Country	:	US
Telephone Number	:	207-689-8464
Fax Number	:

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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