Individual
MRS. BETTYE BOGGS-COSTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2747 4TH ST, BRUNSWICK, GA 31520-3714
(912) 264-3961
(912) 265-8837
Mailing address
2747 4TH ST, BRUNSWICK, GA 31520-3714
(912) 264-3961
(912) 265-8837
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN019053
GA
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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