Provider Demographics
NPI:1093250334
Name:ROGERS, LAURA ANN (CFNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:STORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5861 BIRCHMONT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2990
Mailing Address - Country:US
Mailing Address - Phone:636-667-4249
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:STE 220
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:314-991-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010898163W00000X
MO2016040138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse