Provider Demographics
NPI:1457638405
Name:ROGERS, MARLENE M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 MAIN ST STE 7-8
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6060
Mailing Address - Country:US
Mailing Address - Phone:716-277-0267
Mailing Address - Fax:716-803-8568
Practice Address - Street 1:8207 MAIN ST STE 7-8
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6060
Practice Address - Country:US
Practice Address - Phone:716-277-0267
Practice Address - Fax:716-803-8568
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336867-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily