Healthcare Provider Details

I. General information

NPI: 1497285977
Provider Name (Legal Business Name): JORDAN E HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN E EPPERSON

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 HAMPSHIRE ST
QUINCY IL
62301-3027
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax: 217-277-2253
Mailing address:
  • Phone: 12172226550
  • Fax: 217-277-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number041415266
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016169
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: