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General NPI Number Information
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NPI Number | 1902203367
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Entity Type | Individual
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Provider Name | BRANDON BOSCH PMHNP, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 4212 SE DIVISION ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97206-1680
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Country | US
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Telephone | 503-963-2575
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Fax | 503-327-8796
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Provider Business Mailing Address
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Address Line | PO BOX 8459
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City | PORTLAND
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State | OR
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Zip | 97207-8459
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Country | US
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Telephone | 503-238-0769
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Fax | 503-764-9042
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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 | AP60801886
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10009817
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60801886
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License Number State | WA
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