Provider Demographics
NPI:1083108567
Name:BOSCO, RACHEL PROVIDENCE (RDN, CSO)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:PROVIDENCE
Last Name:BOSCO
Suffix:
Gender:F
Credentials:RDN, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 SE GLENRIDGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:973-557-8135
Mailing Address - Fax:
Practice Address - Street 1:4729 SE GLENRIDGE TRAIL
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:973-557-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education