Provider Demographics
NPI:1518939289
Name:ROGERS, CYNTHIA RAE (CNM)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836B STONE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4041
Mailing Address - Country:US
Mailing Address - Phone:206-324-4815
Mailing Address - Fax:
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 190
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-368-6670
Practice Address - Fax:206-368-6171
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001893367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604943Medicaid
WA9604943Medicaid