Provider Demographics
NPI:1821216854
Name:BOSWELL, HARRIET A (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:A
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 LOCKE SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-477-3679
Mailing Address - Fax:
Practice Address - Street 1:433 MILAN ST S
Practice Address - Street 2:RYAN TREWIN
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614
Practice Address - Country:US
Practice Address - Phone:330-854-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2331702374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
2331702Medicare ID - Type Unspecified
1944Medicare UPIN