Provider Demographics
NPI:1902908957
Name:ROGERS, DANA (CRNA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LONDONDERRY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7920
Mailing Address - Country:US
Mailing Address - Phone:254-776-0266
Mailing Address - Fax:
Practice Address - Street 1:405 LONDONDERRY DR STE 105
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7920
Practice Address - Country:US
Practice Address - Phone:254-776-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730657-01Medicaid
TX8D2632Medicare PIN
TXP00192376Medicare PIN