MEDICARE: MICHAEL HOGAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN119291	LA
2	363LF0000X	Family Nurse Practitioner	AP08468	LA

General Provider Information

NPI Number	:	1194100891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOGAN NP

Provider Business Mailing Address
First Line	:	24950 ARLINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-6602
Country	:	US
Telephone Number	:	225-892-4805
Fax Number	:

Provider Business Practice Location Address
First Line	:	24950 ARLINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-6602
Country	:	US
Telephone Number	:	225-892-4805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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