Provider Demographics
NPI:1184061178
Name:ROGERS, TONYA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 N HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:TAMASSEE
Mailing Address - State:SC
Mailing Address - Zip Code:29686-2736
Mailing Address - Country:US
Mailing Address - Phone:864-886-4540
Mailing Address - Fax:864-886-4539
Practice Address - Street 1:9950 N HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:TAMASSEE
Practice Address - State:SC
Practice Address - Zip Code:29686-2736
Practice Address - Country:US
Practice Address - Phone:864-886-4540
Practice Address - Fax:864-886-4539
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP29958164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC164W00000XMedicaid