Provider Demographics
NPI:1932390754
Name:BRENDA M VOGL,LLC
Entity Type:Organization
Organization Name:BRENDA M VOGL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:VOGL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,ANP
Authorized Official - Phone:480-227-1618
Mailing Address - Street 1:4545 E CHANDLER BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7643
Mailing Address - Country:US
Mailing Address - Phone:480-785-7546
Mailing Address - Fax:
Practice Address - Street 1:4545 E CHANDLER BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7643
Practice Address - Country:US
Practice Address - Phone:480-785-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN066390363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1306972989OtherNPI