MEDICARE: DEBRA LYNN RODGERS 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
1	363LF0000X	Family Nurse Practitioner	15987	CA

General Provider Information

NPI Number	:	1144318957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA LYNN RODGERS NP

Provider Business Mailing Address
First Line	:	27646 CORTE DEL SOL
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-5924
Country	:	US
Telephone Number	:	951-243-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	6896 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2843
Country	:	US
Telephone Number	:	951-787-4885
Fax Number	:	951-787-4962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	12/28/2011

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