Provider Demographics
NPI:1275389785
Name:RODGERS, TASHAUNDA MONEQUE
Entity Type:Individual
Prefix:
First Name:TASHAUNDA
Middle Name:MONEQUE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 FM 1960 RD W APT 732
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3436
Mailing Address - Country:US
Mailing Address - Phone:725-248-8315
Mailing Address - Fax:
Practice Address - Street 1:10206 ROSEHAVEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-3612
Practice Address - Country:US
Practice Address - Phone:725-248-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343548350002311Z00000X
311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility