Provider Demographics
NPI:1982676615
Name:BOESE, BRIDEY LEIGH (RN CNP)
Entity Type:Individual
Prefix:
First Name:BRIDEY
Middle Name:LEIGH
Last Name:BOESE
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:BRIDEY
Other - Middle Name:LEIGH
Other - Last Name:BORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 SOUTH SIBLEY AVENUE
Mailing Address - Street 2:AFFILIATED COMMUNITY MEDICAL CENTERS
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355
Mailing Address - Country:US
Mailing Address - Phone:320-693-3233
Mailing Address - Fax:320-693-3290
Practice Address - Street 1:551 4TH ST N
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-4523
Practice Address - Country:US
Practice Address - Phone:952-442-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2005005721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine