Individual
SHANELL BOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2122 N 127TH CT E, WICHITA, KS 67206-3003
(620) 635-6454
Mailing address
2122 N 127TH CT E, WICHITA, KS 67206-3003
(620) 635-6454
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
120305
KS
363LA2100X
Acute Care Nurse Practitioner
Primary
82483
KS
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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