Provider Demographics
NPI:1275092280
Name:BOS, NADINE NICKE (DO)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:NICKE
Last Name:BOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:NICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-5566
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST # 182
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6932
Practice Address - Fax:919-286-6823
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program