Provider Demographics
NPI:1134123672
Name:BOGGS, HELAINE M (RN NPF)
Entity Type:Individual
Prefix:
First Name:HELAINE
Middle Name:M
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RN NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3196
Mailing Address - Country:US
Mailing Address - Phone:760-446-8281
Mailing Address - Fax:760-446-8289
Practice Address - Street 1:1111 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3196
Practice Address - Country:US
Practice Address - Phone:760-446-8281
Practice Address - Fax:760-446-8289
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
110039741OtherRAILROAD MEDICARE
220561534OtherPALMETTO
0616650001OtherDME
654351OtherAHI HEALTHLINK
00G356060OtherBLUE CROSS
ZZZ27989ZOtherBLUE SHIELD
CA00G356060Medicaid
G35606OtherIMG
00G356060OtherCOMMERCIAL INS
93555B130OtherWPS TRICARE
93555B130OtherWPS TRICARE
CA00G356060Medicaid
Q06167Medicare UPIN