Provider Demographics
NPI:1528346046
Name:BOSSE, JOHN D (MS, RD, NSCA-CPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:BOSSE
Suffix:
Gender:M
Credentials:MS, RD, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4334
Mailing Address - Country:US
Mailing Address - Phone:207-689-8464
Mailing Address - Fax:
Practice Address - Street 1:18 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4334
Practice Address - Country:US
Practice Address - Phone:207-689-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered