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General NPI Number Information
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NPI Number | 1083912349
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Entity Type | Individual
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Provider Name | THERESA STARKS ROGERS PBT(ASCP)
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Gender | Female
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 1201 CENTRAL AVE
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City | GREAT FALLS
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State | MT
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Zip | 59401-3775
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Country | US
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Telephone | 406-454-3247
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Fax | 406-454-0718
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Provider Business Mailing Address
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Address Line | 1201 CENTRAL AVE
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City | GREAT FALLS
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State | MT
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Zip | 59401-3775
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Country | US
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Telephone | 406-454-3247
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Fax | 406-454-0718
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | 457
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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