Provider Demographics
NPI:1134558109
Name:BOSER, ROXANNE (NP-C)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:BOSER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 COUNTY ROAD 138
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9442
Mailing Address - Country:US
Mailing Address - Phone:320-290-8265
Mailing Address - Fax:
Practice Address - Street 1:3701 12TH ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2255
Practice Address - Country:US
Practice Address - Phone:320-253-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-10
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 5020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily