Healthcare Provider Details

I. General information

NPI: 1710695325
Provider Name (Legal Business Name): ALEXANDRIA BOSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 W CHANDLER HEIGHTS RD
CHANDLER AZ
85248-5724
US

IV. Provider business mailing address

6285 S HIGLEY RD
GILBERT AZ
85298-4262
US

V. Phone/Fax

Practice location:
  • Phone: 480-460-4949
  • Fax: 480-460-5858
Mailing address:
  • Phone: 480-460-4949
  • Fax: 480-460-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN205985
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number289060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: