Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | COA 16138-NP | OH |
NPI | 1033524947 |
---|---|
Provider Name | Samantha Michelle Bogner |
First Address | Cleveland, OH 44195-0002 |
Second Address | Cleveland, OH 44195-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 30/06/2014 |