Provider Demographics
NPI:1467687871
Name:BOGUS, JENNIFER E (ND)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:BOGUS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CUMBERLAND AVE #808
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-228-5887
Mailing Address - Fax:207-221-1043
Practice Address - Street 1:211 CUMBERLAND AVE #808
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-228-5887
Practice Address - Fax:207-221-1043
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1675175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath