Provider Demographics
NPI:1629706692
Name:RODGERSON, KRISTEN ANN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:RODGERSON
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 1:335 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0400
Mailing Address - Country:US
Mailing Address - Phone:207-735-4692
Mailing Address - Fax:
Practice Address - Street 1:335 FULLER RD
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0400
Practice Address - Country:US
Practice Address - Phone:207-735-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN73922163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice