Provider Demographics
NPI:1639266240
Name:ROGERS, SUZANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:127 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1733
Practice Address - Country:US
Practice Address - Phone:570-673-3197
Practice Address - Fax:570-673-8297
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN304256L363L00000X
PATP003771B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS479200002Medicare PIN
PAS47920Medicare UPIN