Healthcare Provider Details

I. General information

NPI: 1891978805
Provider Name (Legal Business Name): JUDY ROGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E REZANOF DR
KODIAK AK
99615-6602
US

IV. Provider business mailing address

1915 E REZANOF DR
KODIAK AK
99615-6602
US

V. Phone/Fax

Practice location:
  • Phone: 907-481-2490
  • Fax: 907-481-2497
Mailing address:
  • Phone: 907-481-2490
  • Fax: 907-481-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number16608
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: