Provider Demographics
NPI:1699012732
Name:ROGERS, CORETTA DEANN
Entity Type:Individual
Prefix:
First Name:CORETTA
Middle Name:DEANN
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 1:7517 COBAL CANYON LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2903
Mailing Address - Country:US
Mailing Address - Phone:702-339-0356
Mailing Address - Fax:
Practice Address - Street 1:416 RANCHO DEL MAR WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2844
Practice Address - Country:US
Practice Address - Phone:702-287-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider