Provider Demographics
NPI:1528130713
Name:BOSA, PAMELA K (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:BOSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:K
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAMELA BOSA, APRN
Mailing Address - Street 1:1120 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2423
Mailing Address - Country:US
Mailing Address - Phone:971-219-8750
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR STE 600
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-314-3829
Practice Address - Fax:844-286-1108
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200040329RN163W00000X
OR201800350NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse