MEDICARE: MRS. OLIVIA C 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
1	363L00000X	Nurse Practitioner	5006425	NC
2	363LA2200X	Adult Health Nurse Practitioner	216597	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19A8U	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1770981003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLIVIA C ROGERS NP

Provider Business Mailing Address
First Line	:	1968 IVY CREEK BLVD BLDG 2503
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3455
Country	:	US
Telephone Number	:	919-765-1090
Fax Number	:	919-765-3498

Provider Business Practice Location Address
First Line	:	1968 IVY CREEK BLVD BLDG 2503
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3455
Country	:	US
Telephone Number	:	919-765-1090
Fax Number	:	919-765-3498

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

Provider Enumeration Date	:	12/19/2014
Last Update Date	:	02/21/2022

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