NPI | 1164047395 |
---|---|
Former Name | BETHANY MARIE BOGANTZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0027203) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0027203) |
363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027203) | |
Enumeration Date | 2020-06-12 |
Last Update Date | 2025-07-21 |