Provider Demographics
NPI:1609424043
Name:ROGERS, ALICIA KEVETTE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KEVETTE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 REHILL AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2519
Mailing Address - Country:US
Mailing Address - Phone:908-243-8647
Mailing Address - Fax:732-463-5538
Practice Address - Street 1:128 REHILL AVE STE 1100
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-243-8647
Practice Address - Fax:732-463-5538
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00941300363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health