Provider Demographics
NPI:1154312627
Name:ROGERS, RAINIE A (PA C)
Entity Type:Individual
Prefix:
First Name:RAINIE
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:RAINIE
Other - Middle Name:A
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1303 NE CUSHING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3887
Mailing Address - Country:US
Mailing Address - Phone:541-388-2333
Mailing Address - Fax:541-330-8230
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3887
Practice Address - Country:US
Practice Address - Phone:541-388-2333
Practice Address - Fax:541-330-8230
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000352912OtherANTHEM
7009628OtherAETNA
Q25024Medicare UPIN
I277612Medicare ID - Type Unspecified