Provider Demographics
NPI:1003028648
Name:BOSACKER, RAQUEL LYN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:RAQUEL
Middle Name:LYN
Last Name:BOSACKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:RAQUEL
Other - Middle Name:LYN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:161 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-1532
Mailing Address - Country:US
Mailing Address - Phone:507-629-8030
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0574073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse