Provider Demographics
NPI:1851009724
Name:BOSCH, JAN MATTHEW (BSN, RN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:JAN MATTHEW
Middle Name:
Last Name:BOSCH
Suffix:
Gender:M
Credentials:BSN, RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S OAK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3528
Mailing Address - Country:US
Mailing Address - Phone:209-848-8410
Mailing Address - Fax:
Practice Address - Street 1:190 S OAK AVE STE 1
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3528
Practice Address - Country:US
Practice Address - Phone:209-848-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily