Provider Demographics
NPI:1114561826
Name:ROGERS, LEXUS MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LEXUS
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 W CENTINELA AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8802
Mailing Address - Country:US
Mailing Address - Phone:323-532-9670
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 801
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4003
Practice Address - Country:US
Practice Address - Phone:424-266-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily