Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R25076 | ND |
NPI | 1003833435 |
---|---|
Provider Name | Ms. Estella Ann Boger |
First Address | Grand Forks, ND 58201-5549 |
Second Address | Grand Forks, ND 58201-4032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 31/07/2012 |