Provider Demographics
NPI:1730310756
Name:ROGERS, SHANAYE LEJUANA (RN)
Entity Type:Individual
Prefix:MS
First Name:SHANAYE
Middle Name:LEJUANA
Last Name:ROGERS
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 1:109 TOULON CT
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3819
Mailing Address - Country:US
Mailing Address - Phone:618-236-3660
Mailing Address - Fax:
Practice Address - Street 1:109 TOULON CT
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3819
Practice Address - Country:US
Practice Address - Phone:618-236-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006026912163W00000X
GARN171260163W00000X
IL041.355485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse