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General NPI Number Information
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NPI Number | 1376180588
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Entity Type | Individual
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Provider Name | JESSICA RENEE ROGERS
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Gender | Female
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 1200 OLD YORK RD
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City | ABINGTON
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State | PA
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Zip | 19001-3720
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Country | US
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Telephone | 215-481-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 MARYLAND RD STE 400
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1225
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Country | US
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Telephone | 215-481-2235
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP020480
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License Number State | PA
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