MEDICARE: MRS. MINDY RENAE BOSANEK APRN, FNP- BC

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	111295	NE

General Provider Information

NPI Number	:	1396021820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINDY RENAE BOSANEK APRN, FNP- BC

Provider Business Mailing Address
First Line	:	11919 CYDNEY LN
Second Line	:
City	:	BLAIR
State	:	NE
Zip	:	68008-6363
Country	:	US
Telephone Number	:	402-871-8973
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S 23RD ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2903
Country	:	US
Telephone Number	:	402-296-5100
Fax Number	:

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

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	06/22/2012

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