Provider Demographics
NPI:1144795915
Name:BOGGS, MICHELE RENE'E
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENE'E
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36208 ECR 1470
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554
Mailing Address - Country:US
Mailing Address - Phone:580-706-9040
Mailing Address - Fax:
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-3628
Practice Address - Country:US
Practice Address - Phone:580-726-2452
Practice Address - Fax:580-726-2483
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician