Provider Demographics
NPI:1710136809
Name:HOGAN, REBECCA JOYCE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JOYCE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JOYCE
Other - Last Name:CREAMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7010 E CHAUNCEY LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3117
Mailing Address - Country:US
Mailing Address - Phone:480-585-5200
Mailing Address - Fax:480-585-5233
Practice Address - Street 1:7010 E CHAUNCEY LN
Practice Address - Street 2:SUITE 225
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3117
Practice Address - Country:US
Practice Address - Phone:480-585-5200
Practice Address - Fax:480-585-5233
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18543363LP0200X
AZAP4317363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ671513Medicaid