Provider Demographics
NPI:1700132552
Name:BOSSINGHAM, DARLENE J (RN)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:J
Last Name:BOSSINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 GRACE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1678
Mailing Address - Country:US
Mailing Address - Phone:616-913-2006
Mailing Address - Fax:616-913-2005
Practice Address - Street 1:1471 GRACE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1678
Practice Address - Country:US
Practice Address - Phone:616-913-2006
Practice Address - Fax:616-913-2005
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse