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General NPI Number Information
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NPI Number | 1265083513
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Entity Type | Individual
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Provider Name | ANNEKIE T BOGUES
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 203-576-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 287 W SPRING ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-3354
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Country | US
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Telephone | 203-443-9500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 122599
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 008541
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License Number State | CT
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