Provider Demographics
NPI:1477067445
Name:BOSWELL, DESIREE COLIEN
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:COLIEN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 CREEKSIDE CENTER DR # I-3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-5232
Mailing Address - Country:US
Mailing Address - Phone:907-205-9125
Mailing Address - Fax:
Practice Address - Street 1:360 E INTL AIRPORT RD STE 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1217
Practice Address - Country:US
Practice Address - Phone:907-563-7700
Practice Address - Fax:907-563-7710
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist