Individual
NICOLE L BOSTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1001 BELLEFONTAINE AVE, LIMA, OH 45804-2800
(419) 228-3335
(419) 998-4586
Mailing address
121 W HIGH ST, 5TH FLOOR, LIMA, OH 45801-4340
(419) 998-4573
(419) 998-4586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN.339224
OH
390200000X
Student in an Organized Health Care Education/Training Program
RN.339224
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060730
—
OH
Enumeration date
01/18/2012
Last updated
11/26/2012
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