Doctor Name: | CHRISTY DAWN BOSWELL |
NPI Number: | 1104175736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 77908 |
Business Practice Address: | 100 S. Bliss Avenue Tahlequah, OK - 74464 |
Business Phone Number: | 9184583100 |
Business Fax Number: | |
Mailing Address: | 1387w 4th St, TAHLEQUAH |
State: | OK |
Postal Code: | 744649766 |
Phone Number: | 9184535554 |
Fax Number: | 9184314112 |
NPI Enumeration Date: | 08/29/2012 |
NPI Last Update Date: | 12/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 77908 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |