Provider Demographics
NPI:1437319233
Name:FOGG, CATHERINE (APRN, PHD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:FOGG
Suffix:
Gender:F
Credentials:APRN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MCGREGOR ST
Mailing Address - Street 2:SUITE LL22
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3748
Mailing Address - Country:US
Mailing Address - Phone:603-663-8701
Mailing Address - Fax:603-663-8766
Practice Address - Street 1:199 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5232
Practice Address - Country:US
Practice Address - Phone:603-663-8718
Practice Address - Fax:603-314-4554
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH022298-23364SC1501X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088212Medicaid