Basic Information
| Provider Information | |||||||||
| NPI: | 1457788515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSQUE | ||||||||
| FirstName: | ROQUE | ||||||||
| MiddleName: | ANGELO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | BSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 RIVER BRIDGE LN APT 101 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381036996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9019212133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 157730 | TN | N | Nursing Service Providers | Registered Nurse | 163W00000X | 722601 | CA | N | Nursing Service Providers | Registered Nurse | 163WM0705X | 157730 | TN | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 163WN0800X | 157730 | TN | Y | Nursing Service Providers | Registered Nurse | Neuroscience | 163WX0800X | 157730 | TN | N | Nursing Service Providers | Registered Nurse | Orthopedic |
No ID Information.