Provider Demographics
NPI:1275831489
Name:ROGERS, PATTYLYNN
Entity Type:Individual
Prefix:
First Name:PATTYLYNN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12167 REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-5735
Mailing Address - Country:US
Mailing Address - Phone:315-762-0146
Mailing Address - Fax:
Practice Address - Street 1:228 EIGHT AVENUE
Practice Address - Street 2:
Practice Address - City:SYLVAN BEACH
Practice Address - State:NY
Practice Address - Zip Code:13157
Practice Address - Country:US
Practice Address - Phone:315-762-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301901-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse