Nicholle Boguslaw, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA055934 Issued in PA

Practice address

1 Kelley Dr
Coal Township, PA 17866-1020

Phone

(570) 644-7890

NPI assigned

Feb 6, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391644800000",
    "number": "1689098931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 JADE AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178218536",
            "telephone_number": "570-594-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KELLEY DR",
            "city": "COAL TOWNSHIP",
            "state": "PA",
            "postal_code": "178661020",
            "telephone_number": "570-644-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGUSLAW",
        "first_name": "NICHOLLE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-06",
        "last_updated": "2014-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055934",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA002976",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanya Badar, M.D
• Margaret Nicole Barrett
• Joanna Bednar, OTR/L
• Michele Linn Bell, RDN
• Shirshak Bhattarai, MD
• Elizabeth Ann Bolig, RN
• Jolene Elizabeth Bressi, PHARMD
• Alexandra Campbell
• Lisa Caruso
• Alakananda Chakrabarty, MD

• Physician Assistant in Coal Township, PA
• Providers in Coal Township, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.