Healthcare Provider Details

I. General information

NPI: 1447859186
Provider Name (Legal Business Name): NICOLE ROGERS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR FL 1
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-2645
  • Fax:
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00070801
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: