Provider Demographics
NPI:1801106067
Name:BOGOLUB, CATHERINE JOHNSON (MD , MS)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JOHNSON
Last Name:BOGOLUB
Suffix:
Gender:F
Credentials:MD , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1424 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2216
Mailing Address - Country:US
Mailing Address - Phone:651-470-6135
Mailing Address - Fax:651-344-0445
Practice Address - Street 1:1424 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2216
Practice Address - Country:US
Practice Address - Phone:651-470-6135
Practice Address - Fax:651-344-0445
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN198133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist