Provider Demographics
NPI:1215745658
Name:BOSSLER, SUSAN RUTH (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTH
Last Name:BOSSLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3022
Mailing Address - Country:US
Mailing Address - Phone:610-763-1774
Mailing Address - Fax:
Practice Address - Street 1:4001 CRESTLINE DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3022
Practice Address - Country:US
Practice Address - Phone:610-763-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine