Provider Demographics
NPI:1437532504
Name:ROGERS, STEPHANIE L (CNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6482 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7312
Mailing Address - Country:US
Mailing Address - Phone:614-856-0327
Mailing Address - Fax:614-856-5100
Practice Address - Street 1:6482 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7312
Practice Address - Country:US
Practice Address - Phone:614-856-0327
Practice Address - Fax:614-856-5100
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17575-NP364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health