Individual
THOMAS BOOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 N 1ST ST, WAUSAU, WI 54403-4754
(715) 362-2600
Mailing address
112 JEFFERSON ST, WEST UNION, IA 52175-1022
(563) 422-3817
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1234
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
D152469
IA
Other
Enumeration date
09/24/2012
Last updated
03/31/2020
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