Provider Demographics
NPI:1821429572
Name:HOGAN, LAURIE RANCIK (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:RANCIK
Last Name:HOGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:2304 WESVILL CT
Practice Address - Street 2:STE 240
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2973
Practice Address - Country:US
Practice Address - Phone:919-571-1567
Practice Address - Fax:919-782-1472
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006633363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821429572Medicaid
NCNCG426AMedicaid