Provider Demographics
NPI:1073221776
Name:ROGERS, TERESITA M
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4662 SOLAR ECLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6587
Mailing Address - Country:US
Mailing Address - Phone:702-717-8941
Mailing Address - Fax:
Practice Address - Street 1:4662 SOLAR ECLIPSE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6587
Practice Address - Country:US
Practice Address - Phone:702-717-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No372600000XNursing Service Related ProvidersAdult Companion