Provider Demographics
NPI:1417964354
Name:HOGAN, JOYCE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:M
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 54TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6318
Mailing Address - Country:US
Mailing Address - Phone:425-672-6400
Mailing Address - Fax:
Practice Address - Street 1:20200 54TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6318
Practice Address - Country:US
Practice Address - Phone:425-672-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10003992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4042HOOtherREGENCE
WA8324782Medicaid
WAAB29519Medicare ID - Type Unspecified
WA8324782Medicaid