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General NPI Number Information
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NPI Number | 1104644871
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Entity Type | Individual
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Provider Name | CARSYN ROSE BOSWELL
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1111 MAIN ST
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City | WAYNE
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State | NE
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Zip | 68787-1181
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Country | US
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Telephone | 402-375-7321
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Fax |
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Provider Business Mailing Address
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Address Line | 5414 OLD CAVERN HWY
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City | CARLSBAD
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State | NM
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Zip | 88220-9176
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Country | US
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Telephone | 208-360-1494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 513906498
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 513906498
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License Number State | NM
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