Provider Demographics
NPI:1114973906
Name:BOSE, DAVID CARL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CARL
Last Name:BOSE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:P.O. BOX 1023
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-0821
Mailing Address - Country:US
Mailing Address - Phone:785-628-8300
Mailing Address - Fax:785-623-4634
Practice Address - Street 1:500 E THORPE ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9625
Practice Address - Country:US
Practice Address - Phone:620-355-7111
Practice Address - Fax:620-355-1527
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200369140AMedicaid
KS200369140AMedicaid