Provider Demographics
NPI:1477826873
Name:ROGERS, BRENDA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RENEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 LEONORA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1801
Mailing Address - Country:US
Mailing Address - Phone:330-701-4930
Mailing Address - Fax:
Practice Address - Street 1:1419 LEONORA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-1801
Practice Address - Country:US
Practice Address - Phone:330-701-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse