MEDICARE: CHARMAINE HOGAN RN

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	163WC1600X	Continuing Education/Staff Development Registered Nurse	842981	TX
2	261Q00000X	Clinic/Center
3	261QA0600X	Adult Day Care Clinic/Center		TX
4	163W00000X	Registered Nurse	842981	TX

General Provider Information

NPI Number	:	1942792395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE HOGAN RN

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1201
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-1921
Country	:	US
Telephone Number	:	940-440-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1201
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-1921
Country	:	US
Telephone Number	:	409-440-2923
Fax Number	:

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	01/25/2022

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