Individual
MS. MARY S. BOSCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1006 W MAIN ST, BOZEMAN, MT 59715-3219
(406) 414-4800
Mailing address
1006 W MAIN ST, BOZEMAN, MT 59715-3219
(406) 414-4800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
578
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122731900
—
WY
Enumeration date
06/04/2006
Last updated
07/23/2021
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