Provider Demographics
NPI:1659124428
Name:BOSSARD, MARIA STADELMAN (CNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:STADELMAN
Last Name:BOSSARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BREWSTER DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3912
Mailing Address - Country:US
Mailing Address - Phone:216-870-8292
Mailing Address - Fax:
Practice Address - Street 1:5900 BREWSTER DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3912
Practice Address - Country:US
Practice Address - Phone:216-870-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN472445163W00000X
OHF11230830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse