Provider Demographics
NPI:1407402209
Name:VOGT, ELLEANOR GRAY (APRN)
Entity Type:Individual
Prefix:
First Name:ELLEANOR
Middle Name:GRAY
Last Name:VOGT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELLEANOR
Other - Middle Name:E
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0909
Mailing Address - Country:US
Mailing Address - Phone:502-559-9434
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:3999 DUTCHMANS LANE
Practice Address - Street 2:MEDICAL PLAZA 1 STE 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-394-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013647363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics