Basic Information
| Provider Information | |||||||||
| NPI: | 1437123551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | HART | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1978687635 | ||||||||
| FaxNumber: | 1978689735 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786876355 | ||||||||
| FaxNumber: | 9786897353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 17419 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 17419 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AA24263 | 01 | MA | HARVARD PILGRIM | OTHER | 0702242 | 05 | MA | MEDICAID | NP9735 | 01 | MA | BLUE CROSS | OTHER |