Provider Demographics
NPI:1659028934
Name:HOGAN, TERESA A
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HOGAN
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 1:67 WHITE DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9570
Mailing Address - Country:US
Mailing Address - Phone:717-424-2508
Mailing Address - Fax:
Practice Address - Street 1:67 WHITE DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9570
Practice Address - Country:US
Practice Address - Phone:717-424-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNOT APPLICABLE