1841209061 NPI number — JULIE HOGEN PMHNP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841209061 NPI number — JULIE HOGEN PMHNP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE HOGEN PMHNP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1841209061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6950 SW HAMPTON STREET
Provider Second Line Business Mailing Address:
#109
Provider Business Mailing Address City Name:
TIGARD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-8330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-620-3200
Provider Business Mailing Address Fax Number:
503-670-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6950 SW HAMPTON STREET
Provider Second Line Business Practice Location Address:
#109
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-8330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-620-3200
Provider Business Practice Location Address Fax Number:
503-670-7888
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOGEN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
LURA
Authorized Official Title or Position:
PMHNP
Authorized Official Telephone Number:
503-620-3200

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 336739-97 . This is a "LLC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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