Provider Demographics
NPI:1376687749
Name:BOGGS, EULA FAYE
Entity Type:Individual
Prefix:MRS
First Name:EULA
Middle Name:FAYE
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 1:10886 MILTON POTSDAM RD
Mailing Address - Street 2:
Mailing Address - City:LAURA
Mailing Address - State:OH
Mailing Address - Zip Code:45337-7713
Mailing Address - Country:US
Mailing Address - Phone:937-947-1894
Mailing Address - Fax:937-947-1894
Practice Address - Street 1:10886 MILTON POTSDAM RD
Practice Address - Street 2:
Practice Address - City:LAURA
Practice Address - State:OH
Practice Address - Zip Code:45337-7713
Practice Address - Country:US
Practice Address - Phone:937-947-1894
Practice Address - Fax:937-947-1894
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2670168Medicaid