Healthcare Provider Details

I. General information

NPI: 1548753684
Provider Name (Legal Business Name): KATY MARIE ZOGG CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SIOUX VALLEY DR
LUVERNE MN
56156-4500
US

IV. Provider business mailing address

805 N QUARTZ AVE
BRANDON SD
57005-2702
US

V. Phone/Fax

Practice location:
  • Phone: 507-283-4476
  • Fax:
Mailing address:
  • Phone: 507-360-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5885
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: