Provider Demographics
NPI:1457788515
Name:BOSQUE, ROQUE ANGELO II (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:ROQUE
Middle Name:ANGELO
Last Name:BOSQUE
Suffix:II
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RIVER BRIDGE LN APT 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-6996
Mailing Address - Country:US
Mailing Address - Phone:901-921-2133
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN157730163W00000X, 163WM0705X, 163WN0800X, 163WX0800X
CA722601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic