Provider Demographics
NPI:1669160255
Name:ZOGG, KATHERINE JO (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JO
Last Name:ZOGG
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JO
Other - Last Name:NICKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 570
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1536
Mailing Address - Country:US
Mailing Address - Phone:310-268-8400
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 570
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1536
Practice Address - Country:US
Practice Address - Phone:310-268-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024992363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health