MEDICARE: MRS. TRACIE NICHELLE ROGERS

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	374U00000X	Home Health Aide
2	163WH0200X	Home Health Registered Nurse	RN364564	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255391892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACIE NICHELLE ROGERS

Provider Business Mailing Address
First Line	:	652 CHUCK WAGON DR
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8319
Country	:	US
Telephone Number	:	614-378-1522
Fax Number	:	614-378-1522

Provider Business Practice Location Address
First Line	:	652 CHUCK WAGON DR
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8319
Country	:	US
Telephone Number	:	614-378-1522
Fax Number	:	614-378-1522

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	04/28/2011

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