Provider Demographics
NPI:1245509488
Name:ROGERS, ALICIA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
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 1:13 GROOVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:12758-5612
Mailing Address - Country:US
Mailing Address - Phone:845-943-0534
Mailing Address - Fax:
Practice Address - Street 1:13 GROOVILLE RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-5612
Practice Address - Country:US
Practice Address - Phone:845-943-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297972164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse