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NPI Code Detail

MEDICARE: MS. MELISSA SUE BOGLE FNP

MEDICARE: MS. MELISSA SUE BOGLE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209007114IL
2363LF0000XFamily Nurse Practitioner2018023341MO

General Provider Information

NPI Number : 1760527691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA SUE BOGLE FNP
Provider Business Mailing Address
First Line : 7334 S LINDBERGH BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63125-4522
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 7334 S LINDBERGH BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63125-4522
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 10/30/2024

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