| NPI | 1528601036 |
|---|---|
| Former Name | ALYSSA SUSAN BOGACKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R215583) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2020-09-24 |