Basic Information
Provider Information
NPI: 1699090183
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOGGS
FirstName: YVETTE
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 589
Address2:  
City: PETERSBURG
State: AK
PostalCode: 998330589
CountryCode: US
TelephoneNumber: 9077724291
FaxNumber: 9077723085
Practice Location
Address1: 103 FRAM ST
Address2:  
City: PETERSBURG
State: AK
PostalCode: 99833
CountryCode: US
TelephoneNumber: 9077724291
FaxNumber: 9077723085
Other Information
ProviderEnumerationDate: 03/29/2010
LastUpdateDate: 03/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WH0200XNUR R 26061AKY Nursing Service ProvidersRegistered NurseHome Health

No ID Information.


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