Provider Demographics
NPI:1124391826
Name:HOGFOSS, NICOLE RAE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RAE
Last Name:HOGFOSS
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 1:1043 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4175
Mailing Address - Country:US
Mailing Address - Phone:406-534-4001
Mailing Address - Fax:
Practice Address - Street 1:1043 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4175
Practice Address - Country:US
Practice Address - Phone:406-534-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist