Provider Demographics
NPI:1780170993
Name:BOSLEY, NICOLE DENEICE (LVN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENEICE
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:PINELAND
Mailing Address - State:TX
Mailing Address - Zip Code:75968-0171
Mailing Address - Country:US
Mailing Address - Phone:936-201-5419
Mailing Address - Fax:
Practice Address - Street 1:708 CHEATHAM STREET
Practice Address - Street 2:
Practice Address - City:PINELAND
Practice Address - State:TX
Practice Address - Zip Code:75968-0171
Practice Address - Country:US
Practice Address - Phone:936-201-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301466164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse