Healthcare Provider Details

I. General information

NPI: 1831460401
Provider Name (Legal Business Name): DOREEN M RODGERS RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 B AVE
AUBURN CA
95603-2605
US

IV. Provider business mailing address

11512 B AVE
AUBURN CA
95603-2605
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-2958
  • Fax: 530-886-2992
Mailing address:
  • Phone: 530-886-2958
  • Fax: 530-885-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number487126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: