Healthcare Provider Details

I. General information

NPI: 1467233049
Provider Name (Legal Business Name): MARIAH ROGERS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD DES PERES RD STE 150
DES PERES MO
63131-1874
US

IV. Provider business mailing address

422 GILLHAM CT
BALLWIN MO
63021-6167
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2010019493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: