Provider Demographics
NPI:1659695203
Name:RODGERS, TRACY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:RODGERS
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:PO BOX 2693
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-2693
Mailing Address - Country:US
Mailing Address - Phone:702-610-3786
Mailing Address - Fax:
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:STE 2
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7502
Practice Address - Country:US
Practice Address - Phone:702-610-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN21794163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care