Provider Demographics
NPI:1144245622
Name:BOSTICK, DONNA L (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 MORNING SUN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8929
Mailing Address - Country:US
Mailing Address - Phone:513-523-2158
Mailing Address - Fax:513-523-0019
Practice Address - Street 1:5225 MORNING SUN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8929
Practice Address - Country:US
Practice Address - Phone:513-523-2158
Practice Address - Fax:513-523-0019
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM06184367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216015Medicaid
OH2216015Medicaid
OHP22837Medicare UPIN