Healthcare Provider Details

I. General information

NPI: 1528042579
Provider Name (Legal Business Name): HEIDI H. ROGERS DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3600
US

IV. Provider business mailing address

PO BOX 158 EL CENTRO FAMILY HEALTH - CREDENTIALING
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7218
  • Fax: 505-753-5815
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-753-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR41491
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR41491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: