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General NPI Number Information
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NPI Number | 1174550016
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Entity Type | Individual
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Provider Name | MARY F SROGA CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 77 E WOODBURY DR SUITE 110
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City | DAYTON
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State | OH
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Zip | 45415-2855
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Country | US
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Telephone | 937-277-1722
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Fax | 937-277-8618
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Provider Business Mailing Address
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Address Line | 2912 SPRINGBORO RD SUITE 201
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City | MORAINE
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State | OH
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Zip | 45439-1674
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Country | US
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Telephone | 937-297-8999
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Fax | 937-297-4852
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | COA.03552-NP
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License Number State | OH
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