Provider Demographics
NPI:1912529942
Name:RODGERS, KATIE ELIZABETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 LITTLE SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1866
Mailing Address - Country:US
Mailing Address - Phone:856-345-4324
Mailing Address - Fax:
Practice Address - Street 1:318 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1739
Practice Address - Country:US
Practice Address - Phone:856-345-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN307815164W00000X
NJ26NP06560000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse