Healthcare Provider Details

I. General information

NPI: 1417450867
Provider Name (Legal Business Name): JOSEPHINE BOSTIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 507
EVANSTON IL
60204-0507
US

IV. Provider business mailing address

PO BOX 507
EVANSTON IL
60204-0507
US

V. Phone/Fax

Practice location:
  • Phone: 678-839-9268
  • Fax:
Mailing address:
  • Phone: 678-839-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277.001540
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209071222
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: