Provider Demographics
NPI:1477557312
Name:RODGERS, ERICA J (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:RODGERS
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:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-0677
Mailing Address - Country:US
Mailing Address - Phone:812-752-4055
Mailing Address - Fax:812-752-5835
Practice Address - Street 1:1441 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:812-752-4055
Practice Address - Fax:812-752-5835
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001135A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN083560GMedicare PIN
INP-99609Medicare UPIN