Provider Demographics
NPI:1902327711
Name:BOGAN, CAROLYN ISABELLE (MSN, FNP-BC, CARN-AP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ISABELLE
Last Name:BOGAN
Suffix:
Gender:F
Credentials:MSN, FNP-BC, CARN-AP
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ISABELLE
Other - Last Name:BOGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1632
Mailing Address - Country:US
Mailing Address - Phone:781-792-4136
Mailing Address - Fax:
Practice Address - Street 1:797 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1623
Practice Address - Country:US
Practice Address - Phone:781-624-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299659363LF0000X
SC21045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily