Most Relevant Information
Provider Data
| NPI Number: | 1003514696 |
| Provider Name: | STACIE MARIE HOGAN BSN, IBCLC |
| Entity Type: | Individual |
| Taxonomy Code: | 163WL0100X |
| Specialty: | Registered Nurse |
| License Number: | L-309498 |
Most Important Dates
| Enumeration Date: | 02/22/2023 |
| Last Updated: | 02/22/2023 |
Provider Practice Location
3142 BRAMBLETON AVE
ROANOKE
VA
240183727
Practice Location Phone/Fax
| Phone: | 5402008662 |
| Fax: |
Provider Mailing Location
5416 SETTER RD
ROANOKE
VA
240128548
Provider Mailing Phone/Fax
| Phone: | 5409158400 |
| Fax: |