Provider Demographics
NPI:1083726947
Name:BOSMAN, SHAWNA K (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:K
Last Name:BOSMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9640
Mailing Address - Country:US
Mailing Address - Phone:360-371-1307
Mailing Address - Fax:
Practice Address - Street 1:8534 DEPOT RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9598
Practice Address - Country:US
Practice Address - Phone:360-354-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006011163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635269Medicaid
WAAB29809Medicare ID - Type Unspecified
WA9635269Medicaid