Nicole Bogan, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

300629-1 Issued in NY

Practice address

104 Waterbury Dr
North Syracuse, NY 13212-2721

Phone

(315) 214-3572

NPI assigned

Dec 23, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293062400000",
    "number": "1033413653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WATERBURY DR",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132122721",
            "telephone_number": "315-214-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WATERBURY DR",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132122721",
            "telephone_number": "315-214-3572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGAN",
        "first_name": "NICOLE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-23",
        "last_updated": "2010-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "300629-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas A Bersani, MD
• Jami Lee Bisesi, L.M.T.
• James J Blenn, R.PH
• Louise Paguette Blujus, LMSW, CASAC
• Mary Elizabeth Boevin, PHARM.D.
• Deidre Bonarrigo, LCSW
• Alexis Marie Borczuk
• Mary Botsford, N.P.
• Sarah Diane Bowers, LCSW-R
• Amy Lynn Branshaw

• Licensed Practical Nurse in North Syracuse, NY
• Providers in North Syracuse, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.