Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00442800 | NJ |
N | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00442800 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00442800 | NJ |
NPI | 1053724799 |
---|---|
Provider Name | Ms. Patricia Hogan |
First Address | Vineland, NJ 08360 |
Second Address | Northfield, NJ 08225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 28/12/2015 |