Provider Demographics
NPI:1518306729
Name:HOAGLAND, NIKKI (STNA)
Entity Type:Individual
Prefix:MISS
First Name:NIKKI
Middle Name:
Last Name:HOAGLAND
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3228
Mailing Address - Country:US
Mailing Address - Phone:740-244-9004
Mailing Address - Fax:
Practice Address - Street 1:128 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3228
Practice Address - Country:US
Practice Address - Phone:740-244-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4014992403133747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant