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General NPI Number Information
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NPI Number | 1881056448
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Entity Type | Individual
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Provider Name | WILLIAM ROGERS APRN NP-C
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 1148 S BLANCA AVE
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City | BOISE
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State | ID
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Zip | 83709-1112
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Country | US
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Telephone | 208-871-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 S BLANCA AVE
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City | BOISE
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State | ID
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Zip | 83709-1112
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Country | US
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Telephone | 208-871-4548
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 55489
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | N-37637
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License Number State | ID
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