Provider Demographics
NPI:1477124410
Name:HOGGARD, LORETTA
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:HOGGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANCING
Mailing Address - State:TN
Mailing Address - Zip Code:37770-2800
Mailing Address - Country:US
Mailing Address - Phone:865-275-4889
Mailing Address - Fax:
Practice Address - Street 1:130 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANCING
Practice Address - State:TN
Practice Address - Zip Code:37770-2800
Practice Address - Country:US
Practice Address - Phone:865-275-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000095403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty