Healthcare Provider Details

I. General information

NPI: 1932467883
Provider Name (Legal Business Name): KATHLEEN FARRELL HOGAN C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 04/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD SUITE 210
FALLS CHURCH VA
22042-2325
US

IV. Provider business mailing address

6400 ARLINGTON BLVD SUITE 210
FALLS CHURCH VA
22042-2325
US

V. Phone/Fax

Practice location:
  • Phone: 703-531-3016
  • Fax: 703-531-3153
Mailing address:
  • Phone: 703-531-3016
  • Fax: 703-531-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024069457
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: