Provider Demographics
NPI:1821058462
Name:ROGNLI, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:ROGNLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1446
Mailing Address - Country:US
Mailing Address - Phone:651-726-9500
Mailing Address - Fax:651-552-1575
Practice Address - Street 1:963 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1446
Practice Address - Country:US
Practice Address - Phone:651-726-9500
Practice Address - Fax:651-552-1575
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN534208000000X
MN092786-6363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA9021016277OtherPREFERRED ONE
MN03195400Medicaid
MN12-03421OtherMEDICA
MN686G4ROOtherBCBS
MN123678OtherUCARE
MNHP25663OtherHEALTH PARTNERS
MN500003241Medicare ID - Type Unspecified
MN686G4ROOtherBCBS