Provider Demographics
NPI:1003671686
Name:BOESCH, JAMIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BOESCH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2109
Mailing Address - Country:US
Mailing Address - Phone:610-200-8144
Mailing Address - Fax:610-735-9970
Practice Address - Street 1:241 S 3RD ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2109
Practice Address - Country:US
Practice Address - Phone:610-200-8144
Practice Address - Fax:610-735-9970
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15046700363LF0000X
NJSP030616208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily