Provider Demographics
NPI:1790137354
Name:BOGLE, BENJAMIN DAVID (DNP, APNP, FNP-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:BOGLE
Suffix:
Gender:M
Credentials:DNP, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 GOLF RD STE 103
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8794
Mailing Address - Country:US
Mailing Address - Phone:715-514-2827
Mailing Address - Fax:888-606-1323
Practice Address - Street 1:3004 GOLF RD STE 100
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8794
Practice Address - Country:US
Practice Address - Phone:715-514-2827
Practice Address - Fax:888-606-1323
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8591363L00000X, 363L00000X
WI7045-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7045-33OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES