Provider Demographics
NPI:1538690417
Name:BOSSMAN, CARLA (LPN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BOSSMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1315
Mailing Address - Country:US
Mailing Address - Phone:507-616-6679
Mailing Address - Fax:
Practice Address - Street 1:2505 WILLMAR AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2711
Practice Address - Country:US
Practice Address - Phone:320-214-2852
Practice Address - Fax:320-214-5855
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 075992-4164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse