Individual
LISA M. BOGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
120 HOSPITAL DR, SUITE 300, LEBANON, MO 65536-9238
(417) 533-6746
(417) 533-6722
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015023431
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124403944
—
MO
Enumeration date
07/22/2015
Last updated
11/10/2015
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