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NPI Code Detail

MEDICARE: CHARIS CRAIG BOSTIAN FNP

MEDICARE:   CHARIS CRAIG BOSTIAN  FNP
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 Practitioner5011682NC

General Provider Information

NPI Number : 1093378291
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARIS CRAIG BOSTIAN FNP
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 330 JAKE ALEXANDER BLVD W STE 101A
Second Line :
City : SALISBURY
State : NC
Zip : 28147-1385
Country : US
Telephone Number : 704-637-5668
Fax Number : 704-637-5605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2019
Last Update Date : 12/15/2022

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Directions to “ CHARIS CRAIG BOSTIAN FNP” Practice Location

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