Healthcare Provider Details

I. General information

NPI: 1376392019
Provider Name (Legal Business Name): JULIE BOSUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14912 DOVEHEART LN
BOWIE MD
20721-3079
US

IV. Provider business mailing address

14912 DOVEHEART LN
BOWIE MD
20721-3079
US

V. Phone/Fax

Practice location:
  • Phone: 770-629-5578
  • Fax: 470-875-0083
Mailing address:
  • Phone: 770-629-5578
  • Fax: 470-875-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR203319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: