Provider Demographics
NPI:1285832212
Name:HOGAN, MICHAL LYNN (RD, LD)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:LYNN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SUMPTION DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1639
Mailing Address - Country:US
Mailing Address - Phone:614-476-8782
Mailing Address - Fax:215-895-9921
Practice Address - Street 1:295 SUMPTION DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1639
Practice Address - Country:US
Practice Address - Phone:614-476-8782
Practice Address - Fax:215-895-9921
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered