Provider Demographics
NPI:1336135557
Name:BOSHOVEN, AMY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BOSHOVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15146 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARNE
Mailing Address - State:MI
Mailing Address - Zip Code:49435-9605
Mailing Address - Country:US
Mailing Address - Phone:616-288-6970
Mailing Address - Fax:616-341-6013
Practice Address - Street 1:15146 16TH AVE
Practice Address - Street 2:
Practice Address - City:MARNE
Practice Address - State:MI
Practice Address - Zip Code:49435-9605
Practice Address - Country:US
Practice Address - Phone:616-288-6970
Practice Address - Fax:616-341-6013
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199423363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB199423OtherBLUE CROSS BLUE SHIELD
AB199423OtherBLUE CROSS BLUE SHIELD