Provider Demographics
NPI:1952731879
Name:ROGERS, MARTINA (LVN)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17923 HOLLOW HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2577
Mailing Address - Country:US
Mailing Address - Phone:832-719-4799
Mailing Address - Fax:
Practice Address - Street 1:17923 HOLLOW HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2577
Practice Address - Country:US
Practice Address - Phone:832-719-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13416164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse