Healthcare Provider Details

I. General information

NPI: 1770092496
Provider Name (Legal Business Name): LINDA ANNE BOSSE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 02/18/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NW 8TH ST
MCMINNVILLE OR
97128-5560
US

IV. Provider business mailing address

4155 N VAL VERDE WAY
PRESCOTT VALLEY AZ
86314-5462
US

V. Phone/Fax

Practice location:
  • Phone: 503-379-0208
  • Fax: 503-662-6068
Mailing address:
  • Phone: 602-697-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP10739
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: