MEDICARE: GRACE ELIZABETH HOGELAND

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710693064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ELIZABETH HOGELAND

Provider Business Mailing Address
First Line	:	121 ORLEANS AVENUE
Second Line	:
City	:	ORLEANS
State	:	NE
Zip	:	68966
Country	:	US
Telephone Number	:	308-995-7582
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S ORLEANS AVE
Second Line	:
City	:	ORLEANS
State	:	NE
Zip	:	68966-6657
Country	:	US
Telephone Number	:	308-995-7582
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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