Provider Demographics
NPI:1447580923
Name:ROGERS, ANDREA DIANE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DIANE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 E 85TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2584
Mailing Address - Country:US
Mailing Address - Phone:918-249-4759
Mailing Address - Fax:
Practice Address - Street 1:11022 E 85TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2584
Practice Address - Country:US
Practice Address - Phone:918-249-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0073430163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant