Provider Demographics
NPI:1750744918
Name:BOSTICK, LINDA (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BOSTICK
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 1:764 MEADOW GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1172
Mailing Address - Country:US
Mailing Address - Phone:937-974-2959
Mailing Address - Fax:937-262-3518
Practice Address - Street 1:1800 N JAMES H MCGEE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-9526
Practice Address - Country:US
Practice Address - Phone:937-262-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.149744163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)