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General NPI Number Information
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NPI Number | 1396300562
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Entity Type | Organization
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Legal Business Name | BROOKE BOGGS LLC
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 403 LEXINGTON CIR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-9728
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Country | US
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Telephone | 308-227-6119
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Fax | 308-888-0018
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Provider Business Mailing Address
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Address Line | 403 LEXINGTON CIR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-9728
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Country | US
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Telephone | 308-227-6119
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Fax | 308-888-0018
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BROOKE NICOLE BOGGS
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Credential | APRN
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Telephone | 308-530-6569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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