Healthcare Provider Details

I. General information

NPI: 1043872765
Provider Name (Legal Business Name): LETISHA HOGANS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A-101
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

81 VILLAGE GREEN LN
SICKLERVILLE NJ
08081-1629
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4800
  • Fax:
Mailing address:
  • Phone: 609-422-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR16581800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00994500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: