Provider Demographics
NPI:1689040461
Name:RODGERS, ELIZABETH (PNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LOMAS BLVD NE
Mailing Address - Street 2:THREE WOODWARD CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2568
Mailing Address - Country:US
Mailing Address - Phone:505-842-5240
Mailing Address - Fax:
Practice Address - Street 1:700 LOMAS BLVD NE, 3 WOODWARD CENTER
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-842-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02746363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics