Provider Demographics
NPI:1275675001
Name:BOGERMAN-BOLLE, KAREN ELISE (ACNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELISE
Last Name:BOGERMAN-BOLLE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:ELISE
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 PIPERS GLN
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2114
Mailing Address - Country:US
Mailing Address - Phone:845-608-7559
Mailing Address - Fax:845-215-5549
Practice Address - Street 1:2 PIPERS GLN
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2114
Practice Address - Country:US
Practice Address - Phone:845-608-7559
Practice Address - Fax:845-215-5549
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302046363LA2100X
NY302046-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF302046OtherMEDICAL LICENSE #
NYMB2972013OtherDEA