Healthcare Provider Details

I. General information

NPI: 1982017364
Provider Name (Legal Business Name): AMANDA MARIE BOSLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39935 VISTA DEL SOL
RANCHO MIRAGE CA
92270-3264
US

IV. Provider business mailing address

48244 SILVER SPUR TRL
PALM DESERT CA
92260-6611
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-9210
  • Fax:
Mailing address:
  • Phone: 440-749-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number268187
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN631182
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.350801
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number670997
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101970
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: