Provider Demographics
NPI:1982017364
Name:BOSLEY, AMANDA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:BOSLEY
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 1:48244 SILVER SPUR TRL
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-6611
Mailing Address - Country:US
Mailing Address - Phone:440-749-9451
Mailing Address - Fax:
Practice Address - Street 1:39935 VISTA DEL SOL
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3264
Practice Address - Country:US
Practice Address - Phone:760-837-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268187163W00000X
PARN631182163W00000X
OHRN.350801163W00000X
NY670997163W00000X
NC101970367500000X
CA95000954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982017364Medicaid
NCQ47395CMedicare PIN