Individual
GAIL P BOSCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2430 E MASON ST, GREEN BAY, WI 54302-3759
(920) 406-9863
Mailing address
2430 E MASON ST, GREEN BAY, WI 54302-3759
(920) 406-9863
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2092
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092
LICENSE
WI
05
—
41935400
—
WI
Enumeration date
01/29/2007
Last updated
04/09/2014
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