Provider Demographics
NPI:1013181163
Name:BOSVELD, SUZETTE GRIER (NP-C)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:GRIER
Last Name:BOSVELD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COTTONTAIL DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4843
Mailing Address - Country:US
Mailing Address - Phone:909-629-8811
Mailing Address - Fax:
Practice Address - Street 1:40 COTTONTAIL DR
Practice Address - Street 2:
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-4843
Practice Address - Country:US
Practice Address - Phone:909-629-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-19
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily