Provider Demographics
NPI:1114035953
Name:BOSCHULTE, MARY LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEE
Last Name:BOSCHULTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 HALLECK PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3222
Mailing Address - Country:US
Mailing Address - Phone:614-732-2481
Mailing Address - Fax:614-236-0632
Practice Address - Street 1:1811 HALLECK PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3222
Practice Address - Country:US
Practice Address - Phone:614-732-2481
Practice Address - Fax:614-236-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP 01416OtherNURSE PRACTITIONER
OHR.N. 143576OtherREGISTERED NURSE LICENSE