Provider Demographics
NPI:1578197505
Name:BOSCHERT, JULIE A (AGNP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3577
Mailing Address - Fax:314-362-2107
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-362-3577
Practice Address - Fax:314-362-2107
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2024-12-30
Deactivation Date:2021-01-20
Deactivation Code:
Reactivation Date:2021-01-22
Provider Licenses
StateLicense IDTaxonomies
MO2019043666363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology