Healthcare Provider Details

I. General information

NPI: 1780375733
Provider Name (Legal Business Name): MAUREEN BOSE BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TRANCAS ST
NAPA CA
94558-2906
US

IV. Provider business mailing address

118 SAGE WAY
NAPA CA
94559-3574
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax:
Mailing address:
  • Phone: 707-253-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-135792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: