Healthcare Provider Details

I. General information

NPI: 1962319848
Provider Name (Legal Business Name): LISA ROGERSON FMCHC, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W LABURNUM AVE
RICHMOND VA
23227-4313
US

IV. Provider business mailing address

1811 W LABURNUM AVE
RICHMOND VA
23227-4313
US

V. Phone/Fax

Practice location:
  • Phone: 804-937-0123
  • Fax:
Mailing address:
  • Phone: 804-937-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: