MEDICARE: MS. ANNA EVELYN HOGAN R.N., P.H.N., B.S.N

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	163WC0400X	Case Management Registered Nurse	590596	CA

General Provider Information

NPI Number	:	1205967254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA EVELYN HOGAN R.N., P.H.N., B.S.N

Provider Business Mailing Address
First Line	:	11743 STONEY PEAK DR
Second Line	:	APT 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4294
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6061 MISSION GORGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4007
Country	:	US
Telephone Number	:	619-528-4036
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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