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General NPI Number Information
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NPI Number | 1457453854
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Entity Type | Individual
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Provider Name | MARK E RODGERS CRNFA
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 1600 S COULTER ST BLDG F
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City | AMARILLO
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State | TX
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Zip | 79106-1710
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Country | US
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Telephone | 806-398-3627
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Fax | 806-351-7801
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Provider Business Mailing Address
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Address Line | PO BOX 3046
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City | MALVERN
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State | PA
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Zip | 19355-0746
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Country | US
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Telephone | 484-913-7434
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 541380
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License Number State | TX
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