Provider Demographics
NPI:1053323345
Name:BOS, DAWN MARIE (PHD, ARNP, FNP,PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:BOS
Suffix:
Gender:F
Credentials:PHD, ARNP, FNP,PMHNP
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:VAN RULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 21ST ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4322
Mailing Address - Country:US
Mailing Address - Phone:507-437-6389
Mailing Address - Fax:507-437-0977
Practice Address - Street 1:101 21ST ST SE STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4322
Practice Address - Country:US
Practice Address - Phone:507-437-6389
Practice Address - Fax:507-337-2926
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3687363LP0808X
MNR127266-2363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1015368OtherPREFERRED ONE
MN39293OtherSIOUX VALLEY HEALTH
MN62-98957OtherMEDICA
MN124524OtherUCARE
MN1338OtherAVERA HEALTH PLANS
MN480633600Medicaid
MNHP24888OtherHEALTH PARTNERS
MNP00054553OtherRR MEDICARE
MN2500762/1775927OtherUNITED HEALTHCARE
MN145L6VAOtherBLUE CROSS BLUE SHIELD
MN3687OtherCERTIFIED NURSE PRACTITIONER LICENSE
MN62-98957OtherMEDICA