Provider Demographics
NPI:1518745769
Name:BOZEMAN, NINA M
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:BOZEMAN
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 1:4701 CHARLES PL APT 2022
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7494
Mailing Address - Country:US
Mailing Address - Phone:414-399-1800
Mailing Address - Fax:
Practice Address - Street 1:2120 N SAINT AUGUSTINE DR STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8041
Practice Address - Country:US
Practice Address - Phone:972-767-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy