Provider Demographics
NPI:1245215581
Name:ABBOTT ROGGE, SUSAN R (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:ABBOTT ROGGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:OB/GYN, #2500, ACC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6930
Mailing Address - Fax:916-734-6666
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:OB/GYN, #2500, ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6930
Practice Address - Fax:916-734-6666
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP1985363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00NP19850Medicaid
CAZZZ14958ZMedicare ID - Type Unspecified
CAS57439Medicare UPIN