Healthcare Provider Details

I. General information

NPI: 1639379597
Provider Name (Legal Business Name): KATHY BOGGS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5986 COUNTY ROAD 93
MT GILEAD OH
43338-0022
US

IV. Provider business mailing address

PO BOX 22
MT GILEAD OH
43338-0022
US

V. Phone/Fax

Practice location:
  • Phone: 419-647-1979
  • Fax:
Mailing address:
  • Phone: 419-947-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN276027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: