Provider Demographics
NPI:1831460401
Name:RODGERS, DOREEN M (RN, PHN)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 B AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2605
Mailing Address - Country:US
Mailing Address - Phone:530-886-2958
Mailing Address - Fax:530-885-2992
Practice Address - Street 1:11512 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2605
Practice Address - Country:US
Practice Address - Phone:530-886-2958
Practice Address - Fax:530-886-2992
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487126163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health