Healthcare Provider Details

I. General information

NPI: 1710093216
Provider Name (Legal Business Name): SUSAN NELL ROGERS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 S TEXAS AVE #B
BRYAN TX
77802-3127
US

IV. Provider business mailing address

1500 UNIVERSITY DR E #100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-595-1700
  • Fax: 979-595-1740
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number231641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: