Healthcare Provider Details

I. General information

NPI: 1942834429
Provider Name (Legal Business Name): NICOLE ANNETTE OGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 28TH AVE S
MOORHEAD MN
56560-4420
US

IV. Provider business mailing address

1132 28TH AVE S
MOORHEAD MN
56560-4420
US

V. Phone/Fax

Practice location:
  • Phone: 218-227-5376
  • Fax: 218-227-5377
Mailing address:
  • Phone: 218-227-5376
  • Fax: 218-227-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: