Provider Demographics
NPI:1033971478
Name:BOSTIC, SYDNEY CAMILLE (LPN)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CAMILLE
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5402
Mailing Address - Country:US
Mailing Address - Phone:304-872-2659
Mailing Address - Fax:304-872-1685
Practice Address - Street 1:131 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-5402
Practice Address - Country:US
Practice Address - Phone:304-872-2659
Practice Address - Fax:304-872-1685
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV41367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse