Provider Demographics
NPI:1871924654
Name:BOSCO, LISA M (NP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BOSCO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-1940
Mailing Address - Country:US
Mailing Address - Phone:973-787-7775
Mailing Address - Fax:
Practice Address - Street 1:1900 UNION VALLEY RD
Practice Address - Street 2:SUITE 303
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-3024
Practice Address - Country:US
Practice Address - Phone:973-706-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00425300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health