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General NPI Number Information
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NPI Number | 1760016778
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Entity Type | Individual
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Provider Name | ERICA LYNN BOGAN MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 3272 MAIN ST FL 2
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City | STRATFORD
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State | CT
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Zip | 06614-4819
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Country | US
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Telephone | 203-380-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BOLT LN
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City | MILFORD
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State | CT
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Zip | 06461-2001
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Country | US
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Telephone | 203-685-1898
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8746
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License Number State | CT
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