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General NPI Number Information
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NPI Number | 1992272405
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Entity Type | Individual
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Provider Name | SAMANTHA NICOLE BOGACZ FNP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 3000 MURVIHILL RD
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City | VALPARAISO
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State | IN
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Zip | 46383-5960
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Country | US
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Telephone | 219-286-3907
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Fax |
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Provider Business Mailing Address
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Address Line | 9120 CONNECTICUT ST STE A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7015
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Country | US
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Telephone | 192-863-9072
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Fax | 219-793-1244
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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 | 28247405A
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License Number State | IN
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