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NPI Code Detail

MEDICARE: MS. JANE BOSTROM MAUGER N.P.

MEDICARE: MS. JANE BOSTROM MAUGER N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704124206MI

General Provider Information

NPI Number : 1033315916
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANE BOSTROM MAUGER N.P.
Provider Business Mailing Address
First Line : 1325 THORNAPPLE RIVER DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-9736
Country : US
Telephone Number : 616-676-0208
Fax Number : 253-679-0208
Provider Business Practice Location Address
First Line : 1490 E BELTLINE AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-4336
Country : US
Telephone Number : 616-940-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 07/08/2007

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