Provider Demographics
NPI:1861841405
Name:BOSLEY, AMITHYST
Entity Type:Individual
Prefix:
First Name:AMITHYST
Middle Name:
Last Name:BOSLEY
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 1:1180 W SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1446
Mailing Address - Country:US
Mailing Address - Phone:541-905-0527
Mailing Address - Fax:
Practice Address - Street 1:1180 W SHERMAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-1446
Practice Address - Country:US
Practice Address - Phone:541-905-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula