Individual
BRIENNA MARIE BOSTANCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(188) 858-4788
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
135.001206
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2023
Last updated
07/01/2023
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