Individual
MIKAYLA LYNN HOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 E COLISEUM BLVD, FORT WAYNE, IN 46805-1445
(260) 481-6656
Mailing address
5601 OLD DOVER BLVD APT 5, FORT WAYNE, IN 46835-2816
(920) 538-6885
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003722A
IN
2255A2300X
Athletic Trainer
—
WV
Other
Enumeration date
07/13/2021
Last updated
04/24/2023
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