Individual
KAITLYN ANN BOOSALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
4331 MAYBERRY ST, OMAHA, NE 68105-1711
(989) 529-8059
Mailing address
4331 MAYBERRY ST, OMAHA, NE 68105-1711
(989) 529-8059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NE
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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