MEDICARE: ANGELA BOGNER APRN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	R0120713	OK
2	363LF0000X	Family Nurse Practitioner	327215	AZ
3	363LF0000X	Family Nurse Practitioner	209527	OK

General Provider Information

NPI Number	:	1801514617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BOGNER APRN NP-C

Provider Business Mailing Address
First Line	:	13301 N MERIDIAN AVE STE 501
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9368
Country	:	US
Telephone Number	:	405-752-0871
Fax Number	:	405-421-0948

Provider Business Practice Location Address
First Line	:	13301 N MERIDIAN AVE STE 501
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9368
Country	:	US
Telephone Number	:	405-752-0871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/18/2025

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