MEDICARE: TARA L VOGEL NP-C

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	363L00000X	Nurse Practitioner	71004675A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000839126	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356622245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L VOGEL NP-C

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 N WAYNE ST
Second Line	:
City	:	NORTH MANCHESTER
State	:	IN
Zip	:	46962-1001
Country	:	US
Telephone Number	:	260-982-2102
Fax Number	:	260-982-2105

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	10/10/2022

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