Provider Demographics
NPI:1164667499
Name:BOSCOE, DARRYL A (LPN)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:A
Last Name:BOSCOE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2211
Mailing Address - Country:US
Mailing Address - Phone:315-216-6649
Mailing Address - Fax:
Practice Address - Street 1:182 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2211
Practice Address - Country:US
Practice Address - Phone:315-216-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse