Provider Demographics
NPI:1063593325
Name:VOGT, ANNE E (F-NP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:VOGT
Suffix:
Gender:F
Credentials:F-NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 S WEBSTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-433-3640
Mailing Address - Fax:920-433-3716
Practice Address - Street 1:744 S WEBSTER AVE FL 2
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3640
Practice Address - Fax:920-433-3716
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2679APNP363L00000X
WI2679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104843260OtherM A
WI41272900Medicaid
WI41272900Medicaid
WIP00929196Medicare Oscar/Certification
WIP00878154Medicare Oscar/Certification
WI002150241Medicare Oscar/Certification
Q58341Medicare UPIN
WI070200025Medicare ID - Type Unspecified
0025Medicare PIN
Q58341Medicare UPIN