Provider Demographics
NPI:1881168516
Name:BOGERT, LEE ANN EVELYNN
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:EVELYNN
Last Name:BOGERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9643
Mailing Address - Country:US
Mailing Address - Phone:704-648-3209
Mailing Address - Fax:
Practice Address - Street 1:3777 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-9643
Practice Address - Country:US
Practice Address - Phone:704-648-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC555873374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide