Provider Demographics
NPI:1164769725
Name:ROBERTSON HOGAN, NADA LYN (LAC, MOM)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:LYN
Last Name:ROBERTSON HOGAN
Suffix:
Gender:F
Credentials:LAC, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24017 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1684
Mailing Address - Country:US
Mailing Address - Phone:651-460-2332
Mailing Address - Fax:
Practice Address - Street 1:24017 ESSEX AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1684
Practice Address - Country:US
Practice Address - Phone:651-460-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist