Healthcare Provider Details

I. General information

NPI: 1417938531
Provider Name (Legal Business Name): EVE BOSNICK MSN,CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MONTGOMERY AVE
PENN VALLEY PA
19072-2036
US

IV. Provider business mailing address

721 STRADONE RD
BALA CYNWYD PA
19004-2113
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-9200
  • Fax:
Mailing address:
  • Phone: 610-668-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP021660
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberUP001994-D
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: