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General NPI Number Information
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NPI Number | 1114055365
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Entity Type | Individual
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Provider Name | BOSHA A GORDON APRN
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 05/22/2011
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Provider Practice Location Address
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Address Line | 1001 MEDICAL ARTS AVE NE # UNM
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2708
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Country | US
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Telephone | 505-272-5132
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 INDIANA ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3427
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Country | US
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Telephone | 505-508-1304
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP00393
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License Number State | NM
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