Provider Demographics
NPI:1790511392
Name:HOGAN, LAUREN NICHOLE
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:NICHOLE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:NICHOLE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19500 E ROSS ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-0515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19500 E ROSS ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0515
Practice Address - Country:US
Practice Address - Phone:405-589-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program