| NPI | 1689260499 |
|---|---|
| Former Name | NICHOLE ANN BOSTICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013978) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F12200448) |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2024-03-06 |