Provider Demographics
NPI:1770981003
Name:ROGERS, OLIVIA C (NP)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:C
Other - Last Name:SCHULZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1968 IVY CREEK BLVD BLDG 2503
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3455
Mailing Address - Country:US
Mailing Address - Phone:919-765-1090
Mailing Address - Fax:919-765-3498
Practice Address - Street 1:1968 IVY CREEK BLVD BLDG 2503
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3455
Practice Address - Country:US
Practice Address - Phone:919-765-1090
Practice Address - Fax:919-765-3498
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006425363L00000X
NC216597363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770981003Medicaid
NC19A8UOtherBCBS NC
NCNCM076BMedicare PIN