Healthcare Provider Details

I. General information

NPI: 1417431958
Provider Name (Legal Business Name): EMILY ANNE OGREN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANNE PROBST PA-C

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 FISH HATCHERY RD
MADISON WI
53715-1909
US

IV. Provider business mailing address

1211 FISH HATCHERY RD
MADISON WI
53715-1909
US

V. Phone/Fax

Practice location:
  • Phone: 608-252-8000
  • Fax: 608-288-6490
Mailing address:
  • Phone: 608-252-8000
  • Fax: 608-288-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4541
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: