Provider Demographics
NPI:1104786516
Name:BOGONI, GRACE ELISABETH
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELISABETH
Last Name:BOGONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32366 S SKAGIT HWY
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8638
Mailing Address - Country:US
Mailing Address - Phone:360-926-5617
Mailing Address - Fax:
Practice Address - Street 1:32366 S SKAGIT HWY
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-8638
Practice Address - Country:US
Practice Address - Phone:360-926-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula