Provider Demographics
NPI:1528042579
Name:ROGERS, HEIDI H (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:H
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DNP, FNP-C
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 158
Mailing Address - Street 2:EL CENTRO FAMILY HEALTH - CREDENTIALING
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5818
Practice Address - Street 1:2010 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3600
Practice Address - Country:US
Practice Address - Phone:505-753-7218
Practice Address - Fax:505-753-5815
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41491363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P77309Medicare UPIN
NM349303403Medicare UPIN
P77309Medicare UPIN