Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | COA.16495-NP | OH |
NPI | 1023412079 |
---|---|
Provider Name | Jessica L Bostater |
First Address | Bowling Green, OH 43402-1600 |
Second Address | Bowling Green, OH 43402-2652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 06/02/2019 |