Individual
ANGELA BOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-PMHNP
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 322-5747
(219) 864-2282
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28231278A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71016038A
IN
Other
Enumeration date
11/27/2020
Last updated
01/13/2025
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