Provider Demographics
NPI:1740388271
Name:ROGERS, PHYLLIS R (RN, BSN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8427
Mailing Address - Country:US
Mailing Address - Phone:704-674-3204
Mailing Address - Fax:704-853-5188
Practice Address - Street 1:4459 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8427
Practice Address - Country:US
Practice Address - Phone:704-674-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC192329163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory