Provider Demographics
NPI:1205172376
Name:ROGERS, MYRTLE NAOMI (RN BSN COLON HYDROTH)
Entity type:Individual
Prefix:MRS
First Name:MYRTLE
Middle Name:NAOMI
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN BSN COLON HYDROTH
Other - Prefix:
Other - First Name:MYRTLE
Other - Middle Name:NAOMI
Other - Last Name:ROGERS-VIDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 10008
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850-9782
Mailing Address - Country:US
Mailing Address - Phone:340-513-2343
Mailing Address - Fax:
Practice Address - Street 1:21 GOLDEN GROVE
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-513-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI4898163W00000X
TXF-MR2125092175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No163W00000XNursing Service ProvidersRegistered Nurse