Provider Demographics
NPI:1063412435
Name:BOOGAART, MEGAN Y (CFNP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:Y
Last Name:BOOGAART
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 TRAILARD DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9641
Mailing Address - Country:US
Mailing Address - Phone:440-527-1412
Mailing Address - Fax:
Practice Address - Street 1:7533 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6001
Practice Address - Country:US
Practice Address - Phone:440-974-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000297136OtherBC/BS #
OH2393388Medicaid
IN200273820Medicaid
IN000000297136OtherBC/BS #
OH2393388Medicaid
IN200273820Medicaid