Doctor Name: | DANIELLE L. BOGUE |
NPI Number: | 1295062537 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 209-007734 |
Business Practice Address: | 2 Terminal Dr Suite 8 East Alton, IL - 620242201 |
Business Phone Number: | 6182580485 |
Business Fax Number: | 6182584815 |
Mailing Address: | 220 E Us Highway 40, Suite 8 TROY |
State: | IL |
Postal Code: | 622942201 |
Phone Number: | 6182580485 |
Fax Number: | 6182584815 |
NPI Enumeration Date: | 11/06/2009 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209-007734 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |