Provider Demographics
NPI:1700866829
Name:BOSCHERT, DOROTHY
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 OCONNELL BLVD
Mailing Address - Street 2:ROOM 120
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4055
Mailing Address - Country:US
Mailing Address - Phone:719-526-8413
Mailing Address - Fax:719-526-3595
Practice Address - Street 1:1853 OCONNELL BLVD
Practice Address - Street 2:ROOM 120
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4055
Practice Address - Country:US
Practice Address - Phone:719-526-8413
Practice Address - Fax:719-526-3595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105220163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management