Provider Demographics
NPI:1003646688
Name:ROGERS, JEANINE LORETTA (CLE, DOULA)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:LORETTA
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CLE, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SAIL CT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5304
Mailing Address - Country:US
Mailing Address - Phone:443-799-3998
Mailing Address - Fax:
Practice Address - Street 1:2200 COLONIAL AVE STE 9
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1915
Practice Address - Country:US
Practice Address - Phone:443-799-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula