Provider Demographics
NPI:1548221427
Name:ROGERS, SUSAN DALE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DALE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HUTCHINSON DR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-7588
Mailing Address - Country:US
Mailing Address - Phone:601-416-0652
Mailing Address - Fax:
Practice Address - Street 1:480 HUTCHINSON DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-7588
Practice Address - Country:US
Practice Address - Phone:601-416-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR833525367500000X
CA3265367500000X
AL1-095909367500000X
TXPENDING367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered