Provider Demographics
NPI:1396516761
Name:BOSMA, NICHOLE ADRIANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ADRIANNE
Last Name:BOSMA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4311
Mailing Address - Country:US
Mailing Address - Phone:509-966-9480
Mailing Address - Fax:
Practice Address - Street 1:504 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4311
Practice Address - Country:US
Practice Address - Phone:509-966-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60174063163W00000X
WAMB8644583207Q00000X
WAAP61521891207Q00000X, 363L00000X
WAF01240502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine