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General NPI Number Information
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NPI Number | 1962854968
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Entity Type | Individual
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Provider Name | MATEJ BOSNJAK FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 9320 PARK WEST BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37923-4301
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Country | US
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Telephone | 865-373-7100
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Fax | 865-374-2029
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Provider Business Mailing Address
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Address Line | 1515 BLACKWOOD DR
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City | KNOXVILLE
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State | TN
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Zip | 37923-1102
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Country | US
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Telephone | 423-202-4415
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN123498
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21295
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN21295
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License Number State | TN
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