Individual
MRS. MARY ELIZABETH BOHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
54 HOSPITAL DR, STE 225, OSAGE BEACH, MO 65065-3050
(573) 302-4406
(573) 302-4408
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2011022114
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326334004
—
MO
01
—
135570041
MEDICARE PTAN
MO
Enumeration date
06/22/2011
Last updated
09/01/2015
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