Doctor Name: | MARK MOGENSEN |
NPI Number: | 1881679900 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 001660 |
Business Practice Address: | 1160 3rd St Lake View, IA - 514507474 |
Business Phone Number: | 7126578555 |
Business Fax Number: | 7126572002 |
Mailing Address: | 1160 3rd St, LAKE VIEW |
State: | IA |
Postal Code: | 514507474 |
Phone Number: | 7126578555 |
Fax Number: | 7126572002 |
NPI Enumeration Date: | 12/12/2005 |
NPI Last Update Date: | 09/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 001660 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |