Healthcare Provider Details

I. General information

NPI: 1124526488
Provider Name (Legal Business Name): TARA PIERCE BOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 GREENWELL SPRINGS RD
BATON ROUGE LA
70814-5014
US

IV. Provider business mailing address

10830 GREENWELL SPRINGS RD
BATON ROUGE LA
70814-5014
US

V. Phone/Fax

Practice location:
  • Phone: 225-444-5125
  • Fax:
Mailing address:
  • Phone: 225-444-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN116000
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: