Provider Demographics
NPI:1093366478
Name:ROGERS, SVETLANA (RN, NP)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 GRESHAM PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7037
Mailing Address - Country:US
Mailing Address - Phone:317-918-9593
Mailing Address - Fax:
Practice Address - Street 1:11020 GRESHAM PL
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7037
Practice Address - Country:US
Practice Address - Phone:317-918-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207693A163W00000X
INF07191399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse