Provider Demographics
NPI:1427728708
Name:COGAR, JENNIFER DARLENE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DARLENE
Last Name:COGAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DARLENE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 E SAGEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4934
Mailing Address - Country:US
Mailing Address - Phone:623-547-3318
Mailing Address - Fax:623-853-0655
Practice Address - Street 1:20895 WEST HAMILTON STREET
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85340
Practice Address - Country:US
Practice Address - Phone:623-547-3318
Practice Address - Fax:623-853-0655
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258438163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool