Provider Demographics
NPI:1871769539
Name:HOGAN, KATHLEEN ANN (APN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N AIRLITE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4912
Mailing Address - Country:US
Mailing Address - Phone:847-695-3200
Mailing Address - Fax:847-622-2073
Practice Address - Street 1:77 N AIRLITE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-695-3200
Practice Address - Fax:847-622-2073
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.003176364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist