Individual
LORETTA ANN BOSTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, PMHNP-BC
Contact information
Practice address
661 LICK BRANCH RD, CHARLESTON, WV 25312-6761
(304) 208-0707
(855) 851-4405
Mailing address
661 LICK BRANCH RD, CHARLESTON, WV 25312-6761
(304) 208-0707
(855) 851-4405
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
106941
WV
367500000X
Certified Registered Nurse Anesthetist
33849
WV
Other
Enumeration date
10/28/2005
Last updated
07/23/2024
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