MEDICARE: SUSAN DALE ROGERS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R833525	MS
2	367500000X	Certified Registered Nurse Anesthetist	3265	CA
3	367500000X	Certified Registered Nurse Anesthetist	1-095909	AL
4	367500000X	Certified Registered Nurse Anesthetist	PENDING	TX

General Provider Information

NPI Number	:	1548221427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DALE ROGERS CRNA

Provider Business Mailing Address
First Line	:	480 HUTCHINSON DR
Second Line	:
City	:	CARTHAGE
State	:	MS
Zip	:	39051-7588
Country	:	US
Telephone Number	:	601-416-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 HUTCHINSON DR
Second Line	:
City	:	CARTHAGE
State	:	MS
Zip	:	39051-7588
Country	:	US
Telephone Number	:	601-416-0652
Fax Number	:

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	09/30/2015

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