Healthcare Provider Details

I. General information

NPI: 1003505850
Provider Name (Legal Business Name): JAZMYN RHEA HOGENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 31ST AVE N APT 208
FARGO ND
58102-1583
US

IV. Provider business mailing address

402 31ST AVE N APT 208
FARGO ND
58102-1583
US

V. Phone/Fax

Practice location:
  • Phone: 701-412-3541
  • Fax:
Mailing address:
  • Phone: 701-412-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR54160
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: