Provider Demographics
NPI:1821546615
Name:ROGALA, ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:ROGALA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 RIVEREDGE DR.
Mailing Address - Street 2:
Mailing Address - City:ELYTRA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1333
Mailing Address - Country:US
Mailing Address - Phone:440-567-2731
Mailing Address - Fax:
Practice Address - Street 1:5534 RIVEREDGE DR.
Practice Address - Street 2:
Practice Address - City:ELYTRA
Practice Address - State:OH
Practice Address - Zip Code:44035-1333
Practice Address - Country:US
Practice Address - Phone:440-567-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146675164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse