=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003671686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE BOESCH MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2024
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 S 3RD ST
-----------------------------------------------------
City | COOPERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18036-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-200-8144
-----------------------------------------------------
Fax | 610-735-9970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 S 3RD ST
-----------------------------------------------------
City | COOPERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18036-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-200-8144
-----------------------------------------------------
Fax | 610-735-9970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15046700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | SP030616
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------