Provider Demographics
NPI:1710927058
Name:ROGERS, CHRISTINA M (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:VAN ERMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:950 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1306
Mailing Address - Country:US
Mailing Address - Phone:414-219-5405
Mailing Address - Fax:
Practice Address - Street 1:950 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1306
Practice Address - Country:US
Practice Address - Phone:414-219-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered