1558342436 NPI number — MRS. JANET HOGAN CNMW

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	HOGAN
Provider First Name	:	JANET
Provider Middle Name	:
Provider Name Prefix Text	:	MRS.
Provider Name Suffix Text	:
Provider Credential Text	:	CNMW
Provider Gender Code	:	F

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1558342436
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	11/07/2008
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	2265 MARKET ST
Provider Second Line Business Mailing Address	:	SUITE B
Provider Business Mailing Address City Name	:	WARREN
Provider Business Mailing Address State Name	:	PA
Provider Business Mailing Address Postal Code	:	163654668
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8147238101
Provider Business Mailing Address Fax Number	:	8147232024

Provider First Line Business Practice Location Address	:	2265 MARKET ST
Provider Second Line Business Practice Location Address	:	SUITE B
Provider Business Practice Location Address City Name	:	WARREN
Provider Business Practice Location Address State Name	:	PA
Provider Business Practice Location Address Postal Code	:	163654668
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	8147238101
Provider Business Practice Location Address Fax Number	:	8147232024
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Telephone Number	:

• Taxonomy code: 367A00000X , with the licence number:  MW008455L , registered in the state of PA .

• Identifier: 118131 . This is a "UNISON/MEDPLUS" identifier . This identifiers is of the category "".
• Identifier: 219413 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: 0017503730002 , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: 026693HXY , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: 00025664001 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: 488219 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "".
• Identifier: S79067 , issued by the state of ( PA ) . This identifiers is of the category "".