Healthcare Provider Details

I. General information

NPI: 1164700019
Provider Name (Legal Business Name): ERICA ROGERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DALE RD
AVON CT
06001-4320
US

IV. Provider business mailing address

30 JORDAN LN
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-8830
  • Fax: 860-674-8984
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004696
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: