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NPI Code Detail

MEDICARE: DANIELLE LEE ROGERS NP

MEDICARE: DANIELLE LEE ROGERS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71008374AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3090540381OTHERINMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P02151167OTHERINRAILROAD PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023592300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE LEE ROGERS NP
Provider Business Mailing Address
First Line : 550 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3239
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2920 S MCINTIRE DR STE 350
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-4215
Country : US
Telephone Number : 812-332-2226
Fax Number : 812-339-2934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2018
Last Update Date : 06/14/2023

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