Provider Demographics
NPI:1255643441
Name:BOSSE, CORINNE LEAH (LPN)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:LEAH
Last Name:BOSSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 GARDEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8700
Mailing Address - Country:US
Mailing Address - Phone:920-264-6390
Mailing Address - Fax:
Practice Address - Street 1:4408 SUNNY SLOPE RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR
Practice Address - State:WI
Practice Address - Zip Code:54209-9211
Practice Address - Country:US
Practice Address - Phone:920-746-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311119-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse