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General NPI Number Information
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NPI Number | 1114302957
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Entity Type | Individual
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Provider Name | THEA NASHIRA HOGUE
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Gender | Female
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 37202 S WOODBRIDGE CIR APT 102
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City | WESTLAND
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State | MI
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Zip | 48185-7249
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Country | US
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Telephone | 248-212-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 37202 S WOODBRIDGE CIR APT 102
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City | WESTLAND
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State | MI
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Zip | 48185-7249
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Country | US
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Telephone | 248-212-3852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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