Provider Demographics
NPI:1629728951
Name:ROGERS, CHRYSANDRA
Entity Type:Individual
Prefix:
First Name:CHRYSANDRA
Middle Name:
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 1:110 DYSART PL APT J
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4300
Mailing Address - Country:US
Mailing Address - Phone:910-929-4687
Mailing Address - Fax:
Practice Address - Street 1:429 PERSON ST STE 6
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5737
Practice Address - Country:US
Practice Address - Phone:910-835-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6536163WH0200X, 3747P1801X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant