Provider Demographics
NPI:1659634400
Name:BOSTIC, BRITTNEY (PA)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:
Other - Last Name:GRIMALDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3315 N 128TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4235
Mailing Address - Country:US
Mailing Address - Phone:716-807-5722
Mailing Address - Fax:
Practice Address - Street 1:14000 BOYS TOWN HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7513
Practice Address - Country:US
Practice Address - Phone:531-355-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2041363A00000X
IA127743363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant