MEDICARE: MRS. EVE BOSNICK MSN,CRNP

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	SP021660	PA
2	363LP0200X	Pediatric Nurse Practitioner	UP001994-D	PA

General Provider Information

NPI Number	:	1417938531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVE BOSNICK MSN,CRNP

Provider Business Mailing Address
First Line	:	721 STRADONE RD
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2113
Country	:	US
Telephone Number	:	610-668-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 MONTGOMERY AVE
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-2036
Country	:	US
Telephone Number	:	610-642-9200
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	05/05/2020

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