Provider Demographics
NPI:1548753684
Name:ZOGG, KATY MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:MARIE
Last Name:ZOGG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N QUARTZ AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-2702
Mailing Address - Country:US
Mailing Address - Phone:507-360-2929
Mailing Address - Fax:
Practice Address - Street 1:1601 SIOUX VALLEY DR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-4500
Practice Address - Country:US
Practice Address - Phone:507-283-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily