Provider Demographics
NPI:1083817381
Name:BOGGS, EVELYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1020 SUNSET SALEM DRIVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019
Mailing Address - Country:US
Mailing Address - Phone:501-316-0705
Mailing Address - Fax:
Practice Address - Street 1:JOHN L. MCCELLAN MEMORIAL VETERANS HOSPITAL
Practice Address - Street 2:4300 WEST 7TH STREET
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR19863163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine