Provider Demographics
NPI:1427198712
Name:ROGAN, MARY JANE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:ROGAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W. BARNARD ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382
Mailing Address - Country:US
Mailing Address - Phone:610-431-9370
Mailing Address - Fax:
Practice Address - Street 1:125 W ROSEDALE AVENUE
Practice Address - Street 2:WEST CHESTER UNIVERSITY
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383
Practice Address - Country:US
Practice Address - Phone:610-436-2509
Practice Address - Fax:610-436-3148
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000766B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner