Healthcare Provider Details

I. General information

NPI: 1033670278
Provider Name (Legal Business Name): ASHANTI BOZEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33062 CHIFFON LN
WINCHESTER CA
92596-1757
US

IV. Provider business mailing address

33062 CHIFFON LN
WINCHESTER CA
92596-1757
US

V. Phone/Fax

Practice location:
  • Phone: 214-258-3995
  • Fax:
Mailing address:
  • Phone: 214-258-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95193389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: