Doctor Name: | EILEEN SARAH HEANUE-BOGUE |
NPI Number: | 1114355195 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | F303822-1 |
Business Practice Address: | 125 U.s. Route 46 Budd Lake, NJ - 07828 |
Business Phone Number: | 9736911111 |
Business Fax Number: | 9736911198 |
Mailing Address: | 125 Route 46, BUDD LAKE |
State: | NJ |
Postal Code: | 07828 |
Phone Number: | 9736911111 |
Fax Number: | 9736911198 |
NPI Enumeration Date: | 10/29/2013 |
NPI Last Update Date: | 10/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | F303822-1 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |