MEDICARE: LAURA GOGAN R.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	163W00000X	Registered Nurse	R046220	ME
2	163WH0200X	Home Health Registered Nurse	R046220	ME

General Provider Information

NPI Number	:	1528381456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GOGAN R.N.

Provider Business Mailing Address
First Line	:	78 PEMBER RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4319
Country	:	US
Telephone Number	:	207-991-2570
Fax Number	:	207-884-6311

Provider Business Practice Location Address
First Line	:	78 PEMBER RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4319
Country	:	US
Telephone Number	:	207-991-2570
Fax Number	:	207-884-6311

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

Provider Enumeration Date	:	03/06/2010
Last Update Date	:	03/06/2010

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Directions to “ LAURA GOGAN R.N.” Practice Location

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