Therese L. Boggiano, RN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704278126 Issued in MI

Practice address

12265 James St
Holland, MI 49424-8613

Phone

(616) 494-5698

NPI assigned

Aug 29, 2012

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

Other names 1

• Therese Kubiak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1699023259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 W SEAWAY DR",
            "address_2": "STE 200",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494443761",
            "telephone_number": "616-494-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12265 JAMES ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248613",
            "telephone_number": "616-494-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGIANO",
        "first_name": "THERESE",
        "middle_name": "L.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "MI",
            "license": "4704278126",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704278126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESE",
            "last_name": "KUBIAK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Quinne Boersma, OTR
• Brian C Boeve
• Cameron Paige Boeve, LLMSW
• Kelly Jo Boeve, LLP
• Theresa Ann Boeve, OTR/L
• Noelle Abigail Bohannon, PA-C
• Sarah Mae Bolman
• Daniel L Bolt, DDS
• Mark A Bombara
• William Barry Bonzelaar, M.D.032354

• Psychiatric/Mental Health Nurse Practitioner in Holland, MI
• Providers in Holland, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.