Healthcare Provider Details

I. General information

NPI: 1053308866
Provider Name (Legal Business Name): LINDA L BOSO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 WASHINGTON BLVD
BELPRE OH
45714-2041
US

IV. Provider business mailing address

418 GRAND PARK DR SUITE 315
PARKERSBURG WV
26105-4000
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-3500
  • Fax: 304-422-7900
Mailing address:
  • Phone: 304-428-3500
  • Fax: 304-422-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18012
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA04113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: