Provider Demographics
NPI:1780817973
Name:ROGERS, MARIE L (RN, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN, FNP
Mailing Address - Street 1:2267 SCHAEFFER RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-823-3029
Mailing Address - Fax:707-823-3029
Practice Address - Street 1:339 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-823-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily