MEDICARE: MRS. KRISTI BOSE APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	112187	NE

General Provider Information

NPI Number	:	1336680396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI BOSE APRN

Provider Business Mailing Address
First Line	:	11404 W DODGE RD STE 300
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2511
Country	:	US
Telephone Number	:	402-898-1113
Fax Number	:	402-819-5588

Provider Business Practice Location Address
First Line	:	11404 W DODGE RD STE 300
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2511
Country	:	US
Telephone Number	:	402-898-1113
Fax Number	:	402-819-5588

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

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	01/06/2022

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