Healthcare Provider Details

I. General information

NPI: 1174556575
Provider Name (Legal Business Name): RHONDA L BOSSIE CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4393
  • Fax: 207-768-4456
Mailing address:
  • Phone: 207-768-4393
  • Fax: 207-768-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR033703
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: