Individual
MARIANNE ROSENWALD BOSCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
555 E BROADWAY AVE, JACKSON, WY 83001-8640
(307) 733-3900
Mailing address
555 E BROADWAY AVE, JACKSON, WY 83001-8640
(307) 733-3900
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
301
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113974600
—
WY
Enumeration date
10/25/2006
Last updated
08/12/2019
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