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General NPI Number Information
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NPI Number | 1699376749
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Entity Type | Individual
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Provider Name | LISA ANN ROGERS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 532 GREENWOOD DR
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City | BURLINGTON
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State | NC
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Zip | 27217-7932
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Country | US
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Telephone | 336-584-2763
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Fax | 336-524-6203
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Provider Business Mailing Address
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Address Line | 532 GREENWOOD DR
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City | BURLINGTON
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State | NC
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Zip | 27217-7932
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Country | US
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Telephone | 336-584-2763
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Fax | 336-524-6203
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCL001047
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License Number State | NC
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