Healthcare Provider Details

I. General information

NPI: 1962054106
Provider Name (Legal Business Name): MELISSA LYNN ROGERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N 2ND ST
FULTON NY
13069-1250
US

IV. Provider business mailing address

21 N 2ND ST
FULTON NY
13069-1250
US

V. Phone/Fax

Practice location:
  • Phone: 315-598-7105
  • Fax:
Mailing address:
  • Phone: 315-598-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344543-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: