Healthcare Provider Details

I. General information

NPI: 1811625882
Provider Name (Legal Business Name): SANDRA FAYE ROGERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MAIN ST
CLINTON IN
47842-2261
US

IV. Provider business mailing address

5130 E ROSE HILL AVE
TERRE HAUTE IN
47805-9610
US

V. Phone/Fax

Practice location:
  • Phone: 765-832-1234
  • Fax:
Mailing address:
  • Phone: 812-239-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28123637A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: