Provider Demographics
NPI:1003315466
Name:RODGERS, MONALISA ANN (CNP)
Entity type:Individual
Prefix:
First Name:MONALISA
Middle Name:ANN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IN
Mailing Address - Zip Code:46740-1020
Mailing Address - Country:US
Mailing Address - Phone:260-368-7370
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IN
Practice Address - Zip Code:46740-1020
Practice Address - Country:US
Practice Address - Phone:260-368-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.427016163W00000X
IN28140094A163W00000X
OHAPRN.CNP.022340363LF0000X
IN71008105A363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health