Healthcare Provider Details

I. General information

NPI: 1598273542
Provider Name (Legal Business Name): ANN J BOSSMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HOLLY BLVD
BRANDON SD
57005-1426
US

IV. Provider business mailing address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0998
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-3853
  • Fax: 605-582-3855
Mailing address:
  • Phone: 605-782-8305
  • Fax: 605-336-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112391
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001601
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: