Provider Demographics
NPI:1578679387
Name:BOSLEY, ELLEN MARIE (MBA, MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:MBA, MS, RD
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, MS, RD
Mailing Address - Street 1:9490 VIRGINIA CENTER BOULEVARD, UNIT 442
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-4802
Mailing Address - Country:US
Mailing Address - Phone:202-273-7868
Mailing Address - Fax:202-273-9148
Practice Address - Street 1:810 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20420-0001
Practice Address - Country:US
Practice Address - Phone:202-273-7868
Practice Address - Fax:202-273-9148
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCR483239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered