Provider Demographics
NPI:1619151107
Name:RODGERS, MICHAEL F (LVN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:RODGERS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 BOYT RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BEACH
Mailing Address - State:TX
Mailing Address - Zip Code:77650-2033
Mailing Address - Country:US
Mailing Address - Phone:409-939-0115
Mailing Address - Fax:
Practice Address - Street 1:1282 BOYT RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL BEACH
Practice Address - State:TX
Practice Address - Zip Code:77650-2033
Practice Address - Country:US
Practice Address - Phone:409-939-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160713164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse