Provider Demographics
NPI:1891549341
Name:BOGART, JESSICA RENEE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:BOGART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20789 E PRINCETON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6057
Mailing Address - Country:US
Mailing Address - Phone:719-680-2666
Mailing Address - Fax:
Practice Address - Street 1:20789 E PRINCETON PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6057
Practice Address - Country:US
Practice Address - Phone:719-680-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1644219163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine