Provider Demographics
NPI:1770092496
Name:BOSSE, LINDA ANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:BOSSE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 N VAL VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5462
Mailing Address - Country:US
Mailing Address - Phone:602-697-8207
Mailing Address - Fax:
Practice Address - Street 1:117 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5560
Practice Address - Country:US
Practice Address - Phone:503-379-0208
Practice Address - Fax:503-662-6068
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10739363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health