MEDICARE: LOUISE JULIETTE BOSMANS NP-C

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
1	363LF0000X	Family Nurse Practitioner	26NN05448900	NJ

General Provider Information

NPI Number	:	1104042662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE JULIETTE BOSMANS NP-C

Provider Business Mailing Address
First Line	:	410 W PARK AVE
Second Line	:
City	:	OAKHURST
State	:	NJ
Zip	:	07755-1215
Country	:	US
Telephone Number	:	732-870-2376
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CEDAR AVE
Second Line	:
City	:	WEST LONG BRANCH
State	:	NJ
Zip	:	07764-1804
Country	:	US
Telephone Number	:	732-571-3464
Fax Number	:	732-263-5353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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