MEDICARE: ANTOINETTE LATRESE RODGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	4704246386	MI

General Provider Information

NPI Number	:	1255287447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE LATRESE RODGERS

Provider Business Mailing Address
First Line	:	36262 EGAN ST
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4419
Country	:	US
Telephone Number	:	313-618-6365
Fax Number	:

Provider Business Practice Location Address
First Line	:	36262 EGAN ST
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4419
Country	:	US
Telephone Number	:	313-618-6365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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