Provider Demographics
NPI:1114747367
Name:BOSO, KRISTIE
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:BOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3327
Mailing Address - Country:US
Mailing Address - Phone:330-853-0061
Mailing Address - Fax:
Practice Address - Street 1:615 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-3327
Practice Address - Country:US
Practice Address - Phone:330-853-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide