Provider Demographics
NPI:1568491157
Name:BOSWELL, MAUREEN M (RD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:ROSGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8448060Medicaid
WA0207233OtherL&I
WA8941054OtherCRIME VICTIMS
WA8448060Medicaid
WA0207233OtherL&I