Provider Demographics
NPI:1437393410
Name:BOGARDUS, ANNEKE JANS (FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:ANNEKE
Middle Name:JANS
Last Name:BOGARDUS
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4010
Mailing Address - Country:US
Mailing Address - Phone:803-278-4120
Mailing Address - Fax:803-649-2027
Practice Address - Street 1:1520 KNOX AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4010
Practice Address - Country:US
Practice Address - Phone:803-278-4120
Practice Address - Fax:803-649-2027
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily