Provider Demographics
NPI:1508952961
Name:BOGER, MARY M (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BOGER
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:1613 N HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH 9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:95 BULLDOG BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-11-09
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9164912174400000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3787XMedicare ID - Type UnspecifiedMEDICARE NUMBER