MEDICARE: MRS. CARMEN LAGAYE BOGLE NP

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
1	363LA2200X	Adult Health Nurse Practitioner	28165253A	IN

General Provider Information

NPI Number	:	1851852727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN LAGAYE BOGLE NP

Provider Business Mailing Address
First Line	:	1050 W 72ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-4037
Country	:	US
Telephone Number	:	317-946-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 W 72ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-4037
Country	:	US
Telephone Number	:	317-946-5602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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