Provider Demographics
NPI:1356688808
Name:ROGERS, VICKIE RENEE (RN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:RENEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-9336
Mailing Address - Country:US
Mailing Address - Phone:509-526-8667
Mailing Address - Fax:509-526-8647
Practice Address - Street 1:800 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-9336
Practice Address - Country:US
Practice Address - Phone:509-526-8667
Practice Address - Fax:509-526-8647
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00107091163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool