Healthcare Provider Details

I. General information

NPI: 1285435255
Provider Name (Legal Business Name): LASHONDA TINETTE ROGERS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 THETA AVE S
BIRMINGHAM AL
35205-3310
US

IV. Provider business mailing address

479 THETA AVE S
BIRMINGHAM AL
35205-3310
US

V. Phone/Fax

Practice location:
  • Phone: 205-602-6301
  • Fax:
Mailing address:
  • Phone: 205-602-6301
  • Fax: 205-602-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-146507
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: