Provider Demographics
NPI:1982840450
Name:HOGAN, JOAN BROOKHYSER (RD, CSR, CD, CLT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BROOKHYSER
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RD, CSR, CD, CLT
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:ELIZABETH
Other - Last Name:BROOKHYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CSR, CD
Mailing Address - Street 1:706 33RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7884
Mailing Address - Country:US
Mailing Address - Phone:253-307-5381
Mailing Address - Fax:
Practice Address - Street 1:706 33RD AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7884
Practice Address - Country:US
Practice Address - Phone:253-307-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000644133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11893415OtherCAQH
WAAB38080Medicare PIN