Healthcare Provider Details

I. General information

NPI: 1679812796
Provider Name (Legal Business Name): CATHY BOSCHERO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N UNION AVE
ROSWELL NM
88201-3267
US

IV. Provider business mailing address

PO BOX 974
ROSWELL NM
88202-0974
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-2121
  • Fax: 575-624-7981
Mailing address:
  • Phone: 575-624-2121
  • Fax: 575-624-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS00056
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR19986
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP00315
License Number StateNM

VIII. Authorized Official

Name: MS. CATHY BOSCHERO
Title or Position: OWNER/OPERATOR
Credential: CNP
Phone: 575-624-2121