Provider Demographics
NPI:1639401573
Name:HOGAN, PEGGY (LPN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-1728
Mailing Address - Country:US
Mailing Address - Phone:507-359-2756
Mailing Address - Fax:
Practice Address - Street 1:6 N MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1728
Practice Address - Country:US
Practice Address - Phone:507-359-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 55685-5164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse