Provider Demographics
NPI:1790250900
Name:ROGERS, REBECCA ELAINE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELAINE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 RR 2222 APT 2404
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1033
Mailing Address - Country:US
Mailing Address - Phone:512-765-9959
Mailing Address - Fax:
Practice Address - Street 1:1001 CYPRESS CREEK RD STE 302
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4469
Practice Address - Country:US
Practice Address - Phone:512-765-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-100484163WL0100X
TX789860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant