Healthcare Provider Details

I. General information

NPI: 1629723812
Provider Name (Legal Business Name): ALLISON BOSSE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 W MAIN ST
NEWARK OH
43055-1345
US

IV. Provider business mailing address

100 W 3RD AVE STE 150
COLUMBUS OH
43201-3260
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-5437
  • Fax: 740-522-9609
Mailing address:
  • Phone: 614-297-1158
  • Fax: 614-299-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberARPN.CNP.0028165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: