Provider Demographics
NPI:1407198914
Name:BOGATELLO, YELENA (AGPCNP, NP-C)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:BOGATELLO
Suffix:
Gender:F
Credentials:AGPCNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-946-4662
Mailing Address - Fax:440-683-1882
Practice Address - Street 1:6803 MAYFIELD RD STE 409
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2214
Practice Address - Country:US
Practice Address - Phone:440-946-4662
Practice Address - Fax:440-683-1882
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH292338163WH0200X
OHRN.292338163WP0808X
OHAG08200167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health