Provider Demographics
NPI:1730497330
Name:RODGERS, PATTI GRACE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:GRACE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2321
Mailing Address - Country:US
Mailing Address - Phone:330-770-5872
Mailing Address - Fax:
Practice Address - Street 1:391 ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2321
Practice Address - Country:US
Practice Address - Phone:330-770-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000136363LP0808X
OHRN193144363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health