Healthcare Provider Details

I. General information

NPI: 1548422348
Provider Name (Legal Business Name): JULIA LYNN ROGERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

2022 KELLE DR
CHESTERTON IN
46304-8708
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-9054
  • Fax: 219-465-1749
Mailing address:
  • Phone: 219-364-3616
  • Fax: 219-364-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002650A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: