Healthcare Provider Details

I. General information

NPI: 1255400578
Provider Name (Legal Business Name): JUDITH ANN RODGERS RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WEHRLE DR
WILLIAMSVILLE NY
14221-7037
US

IV. Provider business mailing address

7282 SHAWNEE RD APT 12
N TONAWANDA NY
14120-1320
US

V. Phone/Fax

Practice location:
  • Phone: 716-276-2123
  • Fax: 716-276-2129
Mailing address:
  • Phone: 716-694-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number278310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: