Provider Demographics
NPI:1245413129
Name:HOGAN, PAMELA C (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-8640
Mailing Address - Country:US
Mailing Address - Phone:775-857-1196
Mailing Address - Fax:
Practice Address - Street 1:2225 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3365
Practice Address - Country:US
Practice Address - Phone:775-359-1199
Practice Address - Fax:775-359-1195
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist