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General NPI Number Information
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NPI Number | 1255643441
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Entity Type | Individual
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Provider Name | CORINNE LEAH BOSSE LPN
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Gender | Female
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 4408 SUNNY SLOPE RD
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City | EGG HARBOR
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State | WI
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Zip | 54209-9211
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Country | US
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Telephone | 920-746-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 2190 GARDEN GROVE LN
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City | GREEN BAY
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State | WI
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Zip | 54311-8700
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Country | US
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Telephone | 920-264-6390
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 311119-31
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License Number State | WI
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