Provider Demographics
NPI:1093753956
Name:HOGUE, ALISA (CNP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2895
Mailing Address - Fax:605-622-2896
Practice Address - Street 1:310 S PENN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4553
Practice Address - Country:US
Practice Address - Phone:605-622-2895
Practice Address - Fax:605-622-2896
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19881Medicaid
255951OtherMIDLANDS CHOICE
SD4992816OtherWELLMARK BCBS OF SD
SD6826952Medicaid
SD9237753OtherDAKOTACARE
255951OtherMIDLANDS CHOICE
SDS102019Medicare PIN
SD9237753OtherDAKOTACARE