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NPI Code Detail

MEDICARE: HEIDI H. ROGERS DNP, FNP-C

MEDICARE: HEIDI H. ROGERS DNP, FNP-C
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
1363L00000XNurse PractitionerR41491NM
2207Q00000XFamily Medicine PhysicianR41491NM

General Provider Information

NPI Number : 1528042579
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI H. ROGERS DNP, FNP-C
Provider Business Mailing Address
First Line : PO BOX 158
Second Line : EL CENTRO FAMILY HEALTH - CREDENTIALING
City : ESPANOLA
State : NM
Zip : 87532-0158
Country : US
Telephone Number : 505-753-7218
Fax Number : 505-753-5818
Provider Business Practice Location Address
First Line : 2010 INDUSTRIAL PARK RD
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3600
Country : US
Telephone Number : 505-753-7218
Fax Number : 505-753-5815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 05/04/2016

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