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General NPI Number Information
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NPI Number | 1932487022
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Entity Type | Individual
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Provider Name | SHELLY ANN BOSTON APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 216 S 7TH ST SUITE 1
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City | VINITA
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State | OK
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Zip | 74301-3742
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Country | US
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Telephone | 918-256-1501
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Fax | 918-323-0460
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Provider Business Mailing Address
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Address Line | 216 SOUTH 7TH STREET SUITE 1
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City | VINITA
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State | OK
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Zip | 74301-3720
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Country | US
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Telephone | 918-256-1501
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Fax | 918-323-0460
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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 | 78693
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License Number State | OK
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