Provider Demographics
NPI:1295975332
Name:ROGGE, SUSAN ELIZEBETH
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZEBETH
Last Name:ROGGE
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:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:CHILCOOT
Mailing Address - State:CA
Mailing Address - Zip Code:96105-0073
Mailing Address - Country:US
Mailing Address - Phone:530-993-4339
Mailing Address - Fax:
Practice Address - Street 1:94146 CHILCOOT AVE.
Practice Address - Street 2:
Practice Address - City:CHILCOOT
Practice Address - State:CA
Practice Address - Zip Code:96105
Practice Address - Country:US
Practice Address - Phone:530-993-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11160LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse