Healthcare Provider Details

I. General information

NPI: 1639559867
Provider Name (Legal Business Name): MARY BOGNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 MARIE AVE
CINCINNATI OH
45248-3200
US

IV. Provider business mailing address

3300 MERCY HEALTH BLVD
CINCINNATI OH
45211-1103
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-5463
  • Fax: 513-598-2242
Mailing address:
  • Phone: 513-233-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.17421-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: