Healthcare Provider Details

I. General information

NPI: 1306058094
Provider Name (Legal Business Name): JANICE ARLENE ROGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL STE 108
BANGOR ME
04401-5087
US

IV. Provider business mailing address

200 DAVIS RD
BANGOR ME
04401-2352
US

V. Phone/Fax

Practice location:
  • Phone: 207-990-9000
  • Fax: 207-945-8645
Mailing address:
  • Phone: 207-947-2151
  • Fax: 207-945-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR051356
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: