Provider Demographics
NPI:1568434264
Name:VOGEL, KATHERINE LORRAINE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LORRAINE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HEALTH PARK BLVD
Mailing Address - Street 2:FLAGLER HOSPITAL
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5784
Mailing Address - Country:US
Mailing Address - Phone:904-819-4342
Mailing Address - Fax:904-819-4936
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:FLAGLER HOSPITAL
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5784
Practice Address - Country:US
Practice Address - Phone:904-819-4342
Practice Address - Fax:904-819-4936
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL878383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered