Healthcare Provider Details

I. General information

NPI: 1184830333
Provider Name (Legal Business Name): M. KRISTEEN ROGERS RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 N SHORE DR
CRYSTAL LAKE IL
60014-5243
US

IV. Provider business mailing address

951 N SHORE DR
CRYSTAL LAKE IL
60014-5243
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-7404
  • Fax: 815-788-0551
Mailing address:
  • Phone: 815-455-7404
  • Fax: 815-788-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: