Basic Information
| Provider Information | |||||||||
| NPI: | 1912909318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OGLE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 1509 RITCHIE HWY | ||||||||
| Address2: | |||||||||
| City: | ARNOLD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210122742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107577600 | ||||||||
| FaxNumber: | 4106268043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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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 | 363LF0000X | R056115 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7560021 | 01 | MD | AETNA PPO | OTHER | 1995999 | 01 | MD | AETNA HMO | OTHER | 545311-01 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 120234 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 500005909 | 01 | MD | RAILROAD MEDICARE | OTHER | 7605-0022 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 076400100 | 05 | MD | MEDICAID |