Healthcare Provider Details

I. General information

NPI: 1225089816
Provider Name (Legal Business Name): RONALD C BOGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SOUTH DR
MOUNT PLEASANT MI
48858-3257
US

IV. Provider business mailing address

1221 SOUTH DR
MOUNT PLEASANT MI
48858-3257
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-6732
  • Fax: 989-772-6810
Mailing address:
  • Phone: 989-772-6732
  • Fax: 989-772-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704187664
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN32477
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-71
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: