Healthcare Provider Details

I. General information

NPI: 1053061036
Provider Name (Legal Business Name): TERESA ROGERS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONGRESS ST
QUINCY MA
02169-0907
US

IV. Provider business mailing address

300 CONGRESS ST
QUINCY MA
02169-0907
US

V. Phone/Fax

Practice location:
  • Phone: 774-319-1355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2323931
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: