Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 95008020 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 95008020 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 95008020 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95008020 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95008020 | CA |
NPI | 1669986840 |
---|---|
Provider Name | Mrs. Nancy Bogdanovic |
First Address | San Pedro, CA 90732-4405 |
Second Address | San Pedro, CA 90731-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2017 |
Last Update Date | 26/11/2017 |