Provider Demographics
NPI:1639559867
Name:BOGNER, MARY (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:BOGNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MERCY HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1103
Mailing Address - Country:US
Mailing Address - Phone:513-233-7100
Mailing Address - Fax:
Practice Address - Street 1:5525 MARIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3200
Practice Address - Country:US
Practice Address - Phone:513-981-5463
Practice Address - Fax:513-598-2242
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17421-NP363L00000X
390200000X
OH17421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program