Provider Demographics
NPI:1427386887
Name:BOSMAN, FAY JEAN (IBCLC, RLC)
Entity Type:Individual
Prefix:MS
First Name:FAY
Middle Name:JEAN
Last Name:BOSMAN
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 NE 41ST CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3646
Mailing Address - Country:US
Mailing Address - Phone:360-910-3558
Mailing Address - Fax:
Practice Address - Street 1:3600 NE 54TH ST
Practice Address - Street 2:UNIT H
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2063
Practice Address - Country:US
Practice Address - Phone:360-910-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602963471OtherUBI