Provider Demographics
NPI:1932769833
Name:ROGERS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-1653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 DUPREE FARM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SC
Practice Address - Zip Code:29321-2712
Practice Address - Country:US
Practice Address - Phone:864-380-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171WH0202XOther Service ProvidersContractorHome Modifications
No376K00000XNursing Service Related ProvidersNurse's Aide