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General NPI Number Information
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NPI Number | 1538205380
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Entity Type | Individual
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Provider Name | GAIL P BOSCO PA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 2430 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3759
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Country | US
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Telephone | 920-406-9863
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3759
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Country | US
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Telephone | 920-406-9863
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2092
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License Number State | WI
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