Provider Demographics
NPI:1760295307
Name:HOGGE, ETHAN FREDERICK I (PCA)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:FREDERICK
Last Name:HOGGE
Suffix:I
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 LAMPLIGHTER DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1419
Mailing Address - Country:US
Mailing Address - Phone:402-594-6236
Mailing Address - Fax:403-594-6236
Practice Address - Street 1:6123 LAMPLIGHTER DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1419
Practice Address - Country:US
Practice Address - Phone:402-594-6236
Practice Address - Fax:403-594-6236
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant