Provider Demographics
NPI:1275506065
Name:ROGERS, LAURIE BING (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:BING
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OLD CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3307
Mailing Address - Country:US
Mailing Address - Phone:410-486-7435
Mailing Address - Fax:410-356-0309
Practice Address - Street 1:23 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5476
Practice Address - Country:US
Practice Address - Phone:410-356-0300
Practice Address - Fax:410-356-0309
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR080640367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091N979FMedicare ID - Type Unspecified