Healthcare Provider Details

I. General information

NPI: 1558589499
Provider Name (Legal Business Name): KATHERINE MARY ROGERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

307 PLYMOUTH ST
MIDDLEBORO MA
02346-1622
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-4500
  • Fax:
Mailing address:
  • Phone: 508-947-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number181279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: