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Organization
PREFERRED IMAGE
Active
Organization
PREFERRED IMAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK MOGENSEN PA-C (PROVIDER)
(712) 830-4840
Entity
Organization
Contact information
Practice address
801 HUDSON ST, LAKE VIEW, IA 51450
(712) 830-4840
(877) 330-2377
Mailing address
460 N STATE RD, LAKE VIEW, IA 51450-7307
(712) 830-3170
(877) 330-2377
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
01/07/2026
Last updated
09/09/2026
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