Provider Demographics
NPI:1528381456
Name:GOGAN, LAURA (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PEMBER RD
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4319
Mailing Address - Country:US
Mailing Address - Phone:207-991-2570
Mailing Address - Fax:207-884-6311
Practice Address - Street 1:78 PEMBER RD
Practice Address - Street 2:
Practice Address - City:LEVANT
Practice Address - State:ME
Practice Address - Zip Code:04456-4319
Practice Address - Country:US
Practice Address - Phone:207-991-2570
Practice Address - Fax:207-884-6311
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER046220163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse