Provider Demographics
NPI:1558371260
Name:BOSSEN, AMY NICHOLS (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOLS
Last Name:BOSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:909 HYDE ST
Mailing Address - Street 2:317
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4822
Mailing Address - Country:US
Mailing Address - Phone:415-885-5888
Mailing Address - Fax:415-885-5886
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:317
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-885-5888
Practice Address - Fax:415-885-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2015-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG54885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00BY957A00Medicaid
CAA52817Medicare UPIN
CA00BY957A00Medicaid