Provider Demographics
NPI:1669884334
Name:ROGERS, TERESA D (RN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:D
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E FORK LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676-3706
Mailing Address - Country:US
Mailing Address - Phone:864-944-1062
Mailing Address - Fax:
Practice Address - Street 1:130 E FORK LITTLE RIVER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SC
Practice Address - Zip Code:29676-3706
Practice Address - Country:US
Practice Address - Phone:864-944-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95670390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty