Provider Demographics
NPI:1992011571
Name:VOGEL, DESIREE (LMP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5124
Mailing Address - Country:US
Mailing Address - Phone:509-551-9254
Mailing Address - Fax:509-293-7779
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-551-9254
Practice Address - Fax:509-293-7779
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60176521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist