Basic Information
| Provider Information | |||||||||
| NPI: | 1033556113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGGS | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | RN, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 LEXINGTON CIR | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688039728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085306569 | ||||||||
| FaxNumber: | 3088880018 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 LEXINGTON CIR | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688039728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082276119 | ||||||||
| FaxNumber: | 3088880018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2013 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | 64593 | NE | N | Nursing Service Providers | Registered Nurse | Home Health | 363LF0000X | 111996 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.