Provider Demographics
NPI:1710168604
Name:BOGLE, JINA L (APRN-NP)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:L
Last Name:BOGLE
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983040 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE, DIVISION OF NEPHROLOGY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-3040
Mailing Address - Country:US
Mailing Address - Phone:402-559-9514
Mailing Address - Fax:
Practice Address - Street 1:983040 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE, DIVISION OF NEPHROLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-3040
Practice Address - Country:US
Practice Address - Phone:402-559-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086156Medicare PIN