Individual
STACEY L HOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2121 HUGHES DR, #310, TOLEDO, OH 43606-3845
(419) 291-3858
(419) 480-8701
Mailing address
2121 HUGHES DR, #310, TOLEDO, OH 43606-3845
(419) 291-3858
(419) 480-8701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096437
—
OH
01
—
1109583
NATONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
OH
Enumeration date
02/21/2013
Last updated
11/03/2023
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