Provider Demographics
NPI:1275239634
Name:ROGERS, SHANICE R
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MAIN ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-3024
Mailing Address - Country:US
Mailing Address - Phone:862-668-9072
Mailing Address - Fax:
Practice Address - Street 1:595 MAIN ST APT 14
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-3024
Practice Address - Country:US
Practice Address - Phone:862-668-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula