Provider Demographics
NPI:1659508786
Name:WOGGON, TARA JANE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JANE
Last Name:WOGGON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18821 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9606
Mailing Address - Country:US
Mailing Address - Phone:419-308-9636
Mailing Address - Fax:
Practice Address - Street 1:18821 MERCER RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9606
Practice Address - Country:US
Practice Address - Phone:419-308-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.092665164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse