MEDICARE: BRIAN J BOSWORTH APRN

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	363LP2300X	Primary Care Nurse Practitioner	0024192634	VA
2	363LA2200X	Adult Health Nurse Practitioner	0024192634	VA

General Provider Information

NPI Number	:	1790580108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J BOSWORTH APRN

Provider Business Mailing Address
First Line	:	46 DIAMOND DR
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-7495
Country	:	US
Telephone Number	:	804-508-8372
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 DIAMOND DR
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-7495
Country	:	US
Telephone Number	:	804-508-8372
Fax Number	:

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

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	04/14/2025

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