Provider Demographics
NPI:1902115413
Name:BOSWELL, BEVERLY DENISE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DENISE
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:DENISE
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:6952 W BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5776
Mailing Address - Country:US
Mailing Address - Phone:414-630-0727
Mailing Address - Fax:
Practice Address - Street 1:6952 W BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5776
Practice Address - Country:US
Practice Address - Phone:414-630-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30506-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse