Provider Demographics
NPI:1376331694
Name:RODGERS, MARTHA ANN (CERTIFIED NUTRIONIST)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CERTIFIED NUTRIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15101 FLOWERING DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-687-3569
Mailing Address - Fax:
Practice Address - Street 1:21550 PERKINSON RD
Practice Address - Street 2:
Practice Address - City:JETERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23083-2009
Practice Address - Country:US
Practice Address - Phone:804-687-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education