Provider Demographics
NPI:1205357084
Name:WOGATSKE, ALISON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:WOGATSKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9093 RIDGEFIELD DR STE 104
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6711
Mailing Address - Country:US
Mailing Address - Phone:301-682-4100
Mailing Address - Fax:
Practice Address - Street 1:18101 PRINCE PHILIP DR STE 2002
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1514
Practice Address - Country:US
Practice Address - Phone:301-774-8686
Practice Address - Fax:301-774-8685
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200199163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse