Provider Demographics
NPI:1780375733
Name:BOSE, MAUREEN (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BOSE
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3574
Mailing Address - Country:US
Mailing Address - Phone:707-253-7071
Mailing Address - Fax:
Practice Address - Street 1:1000 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2906
Practice Address - Country:US
Practice Address - Phone:707-252-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-135792163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant