Provider Demographics
NPI:1225292832
Name:HOGANSON, CYNTHIA MARIE (RN BSN CDE)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:HOGANSON
Suffix:
Gender:F
Credentials:RN BSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7696 E CLAYMORE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1842
Mailing Address - Country:US
Mailing Address - Phone:734-453-5471
Mailing Address - Fax:
Practice Address - Street 1:7696 E CLAYMORE CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1842
Practice Address - Country:US
Practice Address - Phone:734-453-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117683163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704117683OtherRN LICENSE