Provider Demographics
NPI:1457110439
Name:VOGT, ALLISON VICTORIA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:VICTORIA
Last Name:VOGT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11560 NE CANYONS RANCH DR
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9584
Mailing Address - Country:US
Mailing Address - Phone:541-390-0663
Mailing Address - Fax:
Practice Address - Street 1:11560 NE CANYONS RANCH DR
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-9584
Practice Address - Country:US
Practice Address - Phone:541-390-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10022697363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health