Basic Information
| Provider Information | |||||||||
| NPI: | 1508828583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOGLAND | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 NORSE ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804015523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204381465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14000 E ARAPAHOE RD | ||||||||
| Address2: | BLDG C, STE #300 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209790840 | ||||||||
| FaxNumber: | 3036905948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 01/19/2011 | ||||||||
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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 | 363A00000X | 1605 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 04855841 | 05 | CO | MEDICAID |