Provider Demographics
NPI:1669744033
Name:BOSTWICK, ELIZABETH MARY (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:108W
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2611
Mailing Address - Country:US
Mailing Address - Phone:703-658-7060
Mailing Address - Fax:
Practice Address - Street 1:7611 LITTLE RIVER TPKE
Practice Address - Street 2:108W
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2611
Practice Address - Country:US
Practice Address - Phone:703-658-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33336913363L00000X
VA0024172751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner