1760436109 NPI number — CHERYL ANN BOSS ANP-BC

Table of content: CHERYL ANN BOSS ANP-BC (NPI 1760436109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760436109 NPI number — CHERYL ANN BOSS ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSS
Provider First Name:
CHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760436109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12251 S 80TH AVE
Provider Second Line Business Mailing Address:
SUITE 1630
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-923-5173
Provider Business Mailing Address Fax Number:
708-923-5018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15300 WEST AVE
Provider Second Line Business Practice Location Address:
SUITE 122 SOUTH
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-403-8400
Provider Business Practice Location Address Fax Number:
708-403-8492
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  209.005516 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F400360785 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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