Provider Demographics
NPI:1114302957
Name:HOGUE, THEA NASHIRA
Entity type:Individual
Prefix:
First Name:THEA
Middle Name:NASHIRA
Last Name:HOGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37202 S WOODBRIDGE CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7249
Mailing Address - Country:US
Mailing Address - Phone:248-212-3852
Mailing Address - Fax:
Practice Address - Street 1:37202 S WOODBRIDGE CIR APT 102
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7249
Practice Address - Country:US
Practice Address - Phone:248-212-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath