Provider Demographics
NPI:1467245134
Name:BOSTIC, JANICE FAE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:FAE
Last Name:BOSTIC
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 OLD VICTOR POST OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938-6811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:342 OLD VICTOR POST OFFICE RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:WV
Practice Address - Zip Code:25938-6811
Practice Address - Country:US
Practice Address - Phone:304-880-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide