Healthcare Provider Details

I. General information

NPI: 1548610934
Provider Name (Legal Business Name): MARIEL BOSSERMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 H ST STE 212
EUREKA CA
95501-0481
US

IV. Provider business mailing address

100 H ST STE 212
EUREKA CA
95501-0481
US

V. Phone/Fax

Practice location:
  • Phone: 707-390-0393
  • Fax: 707-440-1524
Mailing address:
  • Phone: 707-390-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95003971
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95003971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: