Provider Demographics
NPI:1720096100
Name:ROGERS, ALICE I (APRN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:I
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:I
Other - Last Name:OLSON NOAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-7142
Practice Address - Fax:402-219-8961
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
37952OtherBCBS
NE470780857 34Medicaid
6719OtherMIDLANDS CHOICE
S24958Medicare UPIN
280795Medicare PIN
6719OtherMIDLANDS CHOICE