Provider Demographics
NPI:1396021820
Name:BOSANEK, MINDY RENAE (APRN, FNP- BC)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:RENAE
Last Name:BOSANEK
Suffix:
Gender:F
Credentials:APRN, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 CYDNEY LN
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-6363
Mailing Address - Country:US
Mailing Address - Phone:402-871-8973
Mailing Address - Fax:
Practice Address - Street 1:211 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2903
Practice Address - Country:US
Practice Address - Phone:402-296-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1466011Medicare PIN