Provider Demographics
NPI:1942770086
Name:RODGERS, ITHAMESIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ITHAMESIA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RIDGE POND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9048
Mailing Address - Country:US
Mailing Address - Phone:803-553-1658
Mailing Address - Fax:
Practice Address - Street 1:2041 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-597-2874
Practice Address - Fax:803-597-2934
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20048363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care