Provider Demographics
NPI:1578197505
Name:BOSCHERT, JULIE A (AGNP-MSN)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:AGNP-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:1070 OLD DES PERES RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1865
Practice Address - Country:US
Practice Address - Phone:314-821-8644
Practice Address - Fax:314-821-4858
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2021-01-22
Deactivation Date:2021-01-20
Deactivation Code:
Reactivation Date:2021-01-22
Provider Licenses
StateLicense IDTaxonomies
MO2019043666363L00000X
MO149626163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse