Provider Demographics
NPI:1760801674
Name:BOSWELL, LORI MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 EAGLE NEST DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4812
Mailing Address - Country:US
Mailing Address - Phone:706-836-0246
Mailing Address - Fax:
Practice Address - Street 1:4090 EAGLE NEST DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4812
Practice Address - Country:US
Practice Address - Phone:706-836-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192824367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered