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General NPI Number Information
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NPI Number | 1699487512
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Entity Type | Individual
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Provider Name | BRANDON MICHAEL HOGAN
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Gender | Male
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 2500 OVERLOOK TER
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City | MADISON
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State | WI
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Zip | 53705-2254
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Country | US
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Telephone | 608-280-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 COON ROCK RD
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City | ARENA
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State | WI
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Zip | 53503-9306
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Country | US
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Telephone | 608-588-5859
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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 | 163WU0100X
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Taxonomy Name | Urology Registered Nurse
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License Number | 242459-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14646-33
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License Number State | WI
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