Provider Demographics
NPI:1487063590
Name:BOSTON, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOSTON
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 1:18448 MAGNOLIA BRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4626
Mailing Address - Country:US
Mailing Address - Phone:225-256-0063
Mailing Address - Fax:225-256-0217
Practice Address - Street 1:18448 MAGNOLIA BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4626
Practice Address - Country:US
Practice Address - Phone:225-256-0063
Practice Address - Fax:225-256-0217
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07997364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health