Healthcare Provider Details

I. General information

NPI: 1477290179
Provider Name (Legal Business Name): NICOLE ROGERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 S CLIFF AVE
SIOUX FALLS SD
57108-8596
US

IV. Provider business mailing address

6215 S CLIFF AVE
SIOUX FALLS SD
57108-8596
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-6675
  • Fax:
Mailing address:
  • Phone: 605-322-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1477290179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: