Healthcare Provider Details

I. General information

NPI: 1205357084
Provider Name (Legal Business Name): ALISON WOGATSKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR STE 2002
OLNEY MD
20832-1514
US

IV. Provider business mailing address

9093 RIDGEFIELD DR STE 104
FREDERICK MD
21701-6711
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-8686
  • Fax: 301-774-8685
Mailing address:
  • Phone: 301-682-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR200199
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR200199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: