MEDICARE: MRS. ALETHA ANN HOGAN L.P.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	04306578	IL

General Provider Information

NPI Number	:	1134362536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALETHA ANN HOGAN L.P.N.

Provider Business Mailing Address
First Line	:	1825 DELMAR AVE
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4508
Country	:	US
Telephone Number	:	618-876-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 DELMAR AVE
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4508
Country	:	US
Telephone Number	:	618-876-0607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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