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General NPI Number Information
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NPI Number | 1053195297
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Entity Type | Individual
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Provider Name | BRANDON KEITH ROGERS FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1721 S STEPHENSON AVE
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3637
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Country | US
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Telephone | 906-774-1313
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Fax |
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Provider Business Mailing Address
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Address Line | N2940 QUINNESEC LAKE ANTOINE RD
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801
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Country | US
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Telephone | 906-399-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704287555
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License Number State | MI
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