Provider Demographics
NPI:1851455851
Name:IMMING-ROGERS, JANICE M (MS,RN,APN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:IMMING-ROGERS
Suffix:
Gender:F
Credentials:MS,RN,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835808
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-5808
Mailing Address - Country:US
Mailing Address - Phone:214-553-5747
Mailing Address - Fax:
Practice Address - Street 1:18170 DALLAS PKWY STE 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7151
Practice Address - Country:US
Practice Address - Phone:972-250-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570258364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7000OtherBCBS
TX096204501Medicaid
TX096204501Medicaid
TXNP7000OtherBCBS