Healthcare Provider Details

I. General information

NPI: 1376276964
Provider Name (Legal Business Name): HOLLI BOSSONS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 STATE ROUTE 100
MACUNGIE PA
18062-9613
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8111
  • Fax:
Mailing address:
  • Phone: 484-526-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006142
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063696
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: