Provider Demographics
NPI:1184830333
Name:ROGERS, M. KRISTEEN (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:M.
Middle Name:KRISTEEN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5243
Mailing Address - Country:US
Mailing Address - Phone:815-455-7404
Mailing Address - Fax:815-788-0551
Practice Address - Street 1:951 N SHORE DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5243
Practice Address - Country:US
Practice Address - Phone:815-455-7404
Practice Address - Fax:815-788-0551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant