Healthcare Provider Details

I. General information

NPI: 1962802488
Provider Name (Legal Business Name): MADELINE VOGENTHALER HOGLUND NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3573
US

IV. Provider business mailing address

2303 BLUFF ST
BOULDER CO
80304-3717
US

V. Phone/Fax

Practice location:
  • Phone: 303-859-7092
  • Fax:
Mailing address:
  • Phone: 303-859-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991229-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: