Individual
MRS. JACQUELINE ANN BOGUCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2300 STATE ROAD 44, OSHKOSH, WI 54904-9137
(920) 233-2373
Mailing address
1001 COMBE ST, RIPON, WI 54971-9221
(920) 748-2703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4368-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4368-024
WI DEPARTMENT OF REG.
WI
Enumeration date
12/20/2006
Last updated
07/08/2007
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