Provider Demographics
NPI:1881917557
Name:BOSCH, EMILY LISBETH (MMS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LISBETH
Last Name:BOSCH
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LISBETH
Other - Last Name:ALVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-5680
Mailing Address - Fax:757-388-5681
Practice Address - Street 1:600 GRESHAM DR STE 204
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-5680
Practice Address - Fax:757-388-5681
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant