Healthcare Provider Details

I. General information

NPI: 1982849410
Provider Name (Legal Business Name): ELIZABETH MARIE ROGERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST SUITE2120
PENN YAN NY
14527-1100
US

IV. Provider business mailing address

417 LIBERTY ST SUITE2120
PENN YAN NY
14527-1100
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-5160
  • Fax:
Mailing address:
  • Phone: 607-794-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number591721-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: