Provider Demographics
NPI:1306025168
Name:BOGDAN, BERTHA ISABEL (WHC-NP)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:ISABEL
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:WHC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1310
Mailing Address - Country:US
Mailing Address - Phone:915-227-0551
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6293
Practice Address - Fax:212-342-2717
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420864363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health