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General NPI Number Information
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NPI Number | 1255172656
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Entity Type | Individual
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Provider Name | KATIE HOGG FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 100 THEDA CLARK MEDICAL PLZ STE 400
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City | NEENAH
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State | WI
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Zip | 54956-2763
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Country | US
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Telephone | 920-725-4527
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Fax |
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Provider Business Mailing Address
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Address Line | W7271 BELLE PLAINE AVE
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City | SHAWANO
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State | WI
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Zip | 54166-6734
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15397-33
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License Number State | WI
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