Provider Demographics
NPI:1497107635
Name:BOSCHERT, ERIN E (APN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:LEAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3400 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1146
Mailing Address - Country:US
Mailing Address - Phone:317-829-5747
Mailing Address - Fax:
Practice Address - Street 1:3400 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222
Practice Address - Country:US
Practice Address - Phone:317-829-5747
Practice Address - Fax:317-237-5777
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006370A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201380570Medicaid