Provider Demographics
NPI:1376929521
Name:BOSO, MIRANDA SUE (C-FNP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:SUE
Last Name:BOSO
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5652
Mailing Address - Country:US
Mailing Address - Phone:304-917-3733
Mailing Address - Fax:304-917-3750
Practice Address - Street 1:2610 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5652
Practice Address - Country:US
Practice Address - Phone:304-917-3733
Practice Address - Fax:304-917-3750
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily