Provider Demographics
NPI:1124231568
Name:ROGERS, DANA LENORE
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:LENORE
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 1:260 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2925
Mailing Address - Country:US
Mailing Address - Phone:330-307-4232
Mailing Address - Fax:
Practice Address - Street 1:1661 GOODLAND DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3931
Practice Address - Country:US
Practice Address - Phone:330-656-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622086Medicaid