Provider Demographics
NPI:1285877175
Name:BOGUE, ELLEN RAE (RN)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RAE
Last Name:BOGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 EXLEY LN
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3313
Mailing Address - Country:US
Mailing Address - Phone:707-459-2177
Mailing Address - Fax:
Practice Address - Street 1:270 N PINE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4334
Practice Address - Country:US
Practice Address - Phone:707-972-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN185100163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health