Provider Demographics
NPI:1023854031
Name:ROGERS, OPAL MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:OPAL
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 LONGWOOD MANOR CT APT 402
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2481
Mailing Address - Country:US
Mailing Address - Phone:757-560-6585
Mailing Address - Fax:
Practice Address - Street 1:13950 LONGWOOD MANOR CT APT 402
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2481
Practice Address - Country:US
Practice Address - Phone:757-560-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001253106163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory