Provider Demographics
NPI:1003164526
Name:RODGERS, SHANNA R (MA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:R
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:R
Other - Last Name:COWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6559 PAW PAW AVE
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-8805
Mailing Address - Country:US
Mailing Address - Phone:269-468-4100
Mailing Address - Fax:
Practice Address - Street 1:6559 PAW PAW AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-8805
Practice Address - Country:US
Practice Address - Phone:269-468-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician