Provider Demographics
NPI:1740418482
Name:MOGENSEN, DONALD LEE
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
Last Name:MOGENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 1/2 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2115
Mailing Address - Country:US
Mailing Address - Phone:307-760-3425
Mailing Address - Fax:
Practice Address - Street 1:1454 1/2 N 7TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2115
Practice Address - Country:US
Practice Address - Phone:307-760-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator