Provider Demographics
NPI:1679969497
Name:BOSWELL, AVA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:AVA
Middle Name:ANN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 LOUISIANA BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1737
Mailing Address - Country:US
Mailing Address - Phone:505-480-5156
Mailing Address - Fax:505-639-4145
Practice Address - Street 1:8204 LOUISIANA BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1737
Practice Address - Country:US
Practice Address - Phone:505-582-2180
Practice Address - Fax:505-639-4145
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1512142084P0800X
NMMD2017-07912084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry