Provider Demographics
NPI:1821128331
Name:BOGGS, BARBARA JEAN (HOME HEALTH PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEAN
Last Name:BOGGS
Suffix:
Gender:F
Credentials:HOME HEALTH PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11554 S WOLFCREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8317
Mailing Address - Country:US
Mailing Address - Phone:937-833-6106
Mailing Address - Fax:937-833-6106
Practice Address - Street 1:117 SYCAMORE ST APT 102
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1740
Practice Address - Country:US
Practice Address - Phone:937-833-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2151380OtherSTATE PROVIDER NUMBER