Provider Demographics
NPI:1851332449
Name:BOGE, EILEEN SHERRY (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:SHERRY
Last Name:BOGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:SHERRY
Other - Last Name:BAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:670 E COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7600
Mailing Address - Country:US
Mailing Address - Phone:208-524-3417
Mailing Address - Fax:
Practice Address - Street 1:670 E COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7600
Practice Address - Country:US
Practice Address - Phone:208-524-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPN88641367500000X
IDAPN12311367500000X
INAPN28173153A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8HF211Medicare PIN
MT8HE796Medicare PIN
OK8HD991Medicare PIN