Healthcare Provider Details

I. General information

NPI: 1528383825
Provider Name (Legal Business Name): CARRIE HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

5321 LAKEVIEW RD
HOPE MILLS NC
28348
US

V. Phone/Fax

Practice location:
  • Phone: 499662834719
  • Fax: 499662834721
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: