Provider Demographics
NPI:1538133947
Name:ROGERS, SANDRA SUE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SUE
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:326 COUNTY ROAD 323
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-2540
Mailing Address - Country:US
Mailing Address - Phone:325-572-5909
Mailing Address - Fax:325-572-5909
Practice Address - Street 1:796 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:DYESS AFB
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:325-696-5432
Practice Address - Fax:325-696-5431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545725363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health