Provider Demographics
NPI:1669155636
Name:BOGACZYK, AYLA RAE (CRNP)
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:RAE
Last Name:BOGACZYK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BENYOU LN
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-3004
Mailing Address - Country:US
Mailing Address - Phone:570-956-9859
Mailing Address - Fax:
Practice Address - Street 1:3912 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4246
Practice Address - Country:US
Practice Address - Phone:717-761-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner