Provider Demographics
NPI:1043720618
Name:HOGAN, BREANNA KAYE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:KAYE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0504
Mailing Address - Country:US
Mailing Address - Phone:509-217-9282
Mailing Address - Fax:
Practice Address - Street 1:7104 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0504
Practice Address - Country:US
Practice Address - Phone:509-217-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist