Basic Information
Provider Information
NPI: 1033556113
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOGGS
FirstName: BROOKE
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: RN, APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 408 S ELM ST
Address2:  
City: NORTH PLATTE
State: NE
PostalCode: 691017531
CountryCode: US
TelephoneNumber: 3085306569
FaxNumber:  
Practice Location
Address1: 111 N DEWEY ST
Address2: STE A
City: NORTH PLATTE
State: NE
PostalCode: 691015439
CountryCode: US
TelephoneNumber: 3086961201
FaxNumber: 3086961205
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 12/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WH0200X64593NEN Nursing Service ProvidersRegistered NurseHome Health
363LF0000X111996NEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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