Provider Demographics
NPI:1508618695
Name:ROGERS, NICOLE (CRANIAL PROTHESIS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRANIAL PROTHESIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-2427
Mailing Address - Country:US
Mailing Address - Phone:203-923-3904
Mailing Address - Fax:
Practice Address - Street 1:6 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-3740
Practice Address - Country:US
Practice Address - Phone:203-923-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist