Provider Demographics
NPI:1902634215
Name:HOGLUND, NATHAN JAMES
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAMES
Last Name:HOGLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ROBERT
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1187 EVERGREEN LN APT 3
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-8850
Mailing Address - Country:US
Mailing Address - Phone:715-828-0604
Mailing Address - Fax:
Practice Address - Street 1:1446 116TH STREET CHIPPEWA FALLS
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-514-1572
Practice Address - Fax:715-514-1576
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIPAR-0000342403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist