Provider Demographics
NPI:1780797977
Name:HOOGE, JEAN (RN CNS)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HOOGE
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SAPPHIRE OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5629
Mailing Address - Country:US
Mailing Address - Phone:210-545-7636
Mailing Address - Fax:
Practice Address - Street 1:2219 SAPPHIRE OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5629
Practice Address - Country:US
Practice Address - Phone:210-545-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407385163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100273OtherTEHAS BEHAVIORAL HEALTH S
TXNPO120Medicare ID - Type Unspecified