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General NPI Number Information
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NPI Number | 1447396940
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Entity Type | Individual
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Provider Name | TERESA LYNN BOSACKER NP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 478 2ND ST
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City | EXCELSIOR
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State | MN
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Zip | 55331-1987
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Country | US
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Telephone | 952-474-3251
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Fax | 952-474-0315
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Provider Business Mailing Address
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Address Line | 1946 WATERFORD LN
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City | CHASKA
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State | MN
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Zip | 55318-2855
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Country | US
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Telephone | 952-239-4645
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Fax | 952-474-0315
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R 093070-1
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License Number State | MN
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