Healthcare Provider Details

I. General information

NPI: 1093250334
Provider Name (Legal Business Name): LAURA ANN ROGERS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANN STORK

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOWLES AVE STE 220
FENTON MO
63026-2395
US

IV. Provider business mailing address

5861 BIRCHMONT PLACE DR
SAINT LOUIS MO
63129-2990
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-0137
  • Fax:
Mailing address:
  • Phone: 636-667-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006010898
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016040138
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: