Provider Demographics
NPI:1982089314
Name:ROGERS, THULI MILLICENT (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:THULI
Middle Name:MILLICENT
Last Name:ROGERS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26265 PRIMA WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-8554
Mailing Address - Country:US
Mailing Address - Phone:661-367-7068
Mailing Address - Fax:
Practice Address - Street 1:26265 PRIMA WAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-8554
Practice Address - Country:US
Practice Address - Phone:310-279-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751497163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine