Provider Demographics
NPI:1902203367
Name:BOSCH, BRANDON (PMHNP, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:BOSCH
Suffix:
Gender:M
Credentials:PMHNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-998-2349
Mailing Address - Fax:360-998-2887
Practice Address - Street 1:831 12TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2403
Practice Address - Country:US
Practice Address - Phone:360-998-2349
Practice Address - Fax:360-998-2887
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60801886363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily