Provider Demographics
NPI:1629190103
Name:ROGERS, ELDEAN (RN)
Entity Type:Individual
Prefix:
First Name:ELDEAN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 W MAIN ST
Mailing Address - Street 2:CO PATHFINDER INC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4214
Mailing Address - Country:US
Mailing Address - Phone:501-982-0528
Mailing Address - Fax:501-985-7777
Practice Address - Street 1:2520 W MAIN ST
Practice Address - Street 2:CO PATHFINDER INC
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4214
Practice Address - Country:US
Practice Address - Phone:501-982-0528
Practice Address - Fax:501-985-7777
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR44445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA083OtherTRICARE NUMBER