Provider Demographics
NPI:1790217065
Name:BOGALE, HANNA (OWNER)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:BOGALE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10340 E COLORADO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-3103
Mailing Address - Country:US
Mailing Address - Phone:720-436-6480
Mailing Address - Fax:
Practice Address - Street 1:1415 S GALENA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1976
Practice Address - Country:US
Practice Address - Phone:720-436-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001773343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20161463843OtherPUBLIC UTILITIES COMMISION