Provider Demographics
NPI:1174817563
Name:ROGERS, REGINA ANN (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 E DUPONT RD
Mailing Address - Street 2:NICU
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1675
Mailing Address - Country:US
Mailing Address - Phone:260-615-4989
Mailing Address - Fax:
Practice Address - Street 1:2520 EAST DUPONT ROAD
Practice Address - Street 2:NICU
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-416-3270
Practice Address - Fax:574-416-3324
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003359A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal