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NPI Code Detail

MEDICARE: GAIL P BOSCO PA

MEDICARE: GAIL P BOSCO PA
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
1363AM0700XMedical Physician Assistant2092WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22092OTHERWILICENSE

General Provider Information

NPI Number : 1538205380
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL P BOSCO PA
Provider Business Mailing Address
First Line : 2430 E MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-3759
Country : US
Telephone Number : 920-406-9863
Fax Number :
Provider Business Practice Location Address
First Line : 2430 E MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-3759
Country : US
Telephone Number : 920-406-9863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 04/09/2014

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Directions to “ GAIL P BOSCO PA” Practice Location

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