Healthcare Provider Details

I. General information

NPI: 1194643536
Provider Name (Legal Business Name): DEBORAH JONELL HOGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 66TH ST
EDINA MN
55435-2111
US

IV. Provider business mailing address

517 WOODLEY ST E
NORTHFIELD MN
55057-2832
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-6561
  • Fax: 952-927-6569
Mailing address:
  • Phone: 952-927-6561
  • Fax: 952-927-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR179305-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: