Healthcare Provider Details

I. General information

NPI: 1699797951
Provider Name (Legal Business Name): DAVID MARK BOSSENMEYER NP FAMILY NURSE PRAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD
COVINGTON LA
70433
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2828
  • Fax:
Mailing address:
  • Phone: 985-230-3066
  • Fax: 985-230-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP03204
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN056359
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03204
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: