Provider Demographics
NPI:1275092280
Name:BOS, NADINE N (DO)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:N
Last Name:BOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:NICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8100
Mailing Address - Fax:
Practice Address - Street 1:992 UNION ST STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3057
Practice Address - Country:US
Practice Address - Phone:207-992-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3857207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine