Provider Demographics
NPI:1396288387
Name:BOSCHULTE, LAWRENCE
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BOSCHULTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302298
Mailing Address - Street 2:P. O. BOX 302298
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-2298
Mailing Address - Country:US
Mailing Address - Phone:340-771-1735
Mailing Address - Fax:
Practice Address - Street 1:# 78 SOLBERG
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-771-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-24079-1L343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)