Provider Demographics
NPI:1184490393
Name:ROGERS, LINDA (RD, LD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WOOD AVE SE UNIT A
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4835
Mailing Address - Country:US
Mailing Address - Phone:218-368-5470
Mailing Address - Fax:
Practice Address - Street 1:312 1ST ST NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3600
Practice Address - Country:US
Practice Address - Phone:218-335-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered