MEDICARE: MS. MILDA HARRIET ROGERS CFNP

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	363LF0000X	Family Nurse Practitioner	AP0372	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN084978	OTHER	AZ	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619952413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MILDA HARRIET ROGERS CFNP

Provider Business Mailing Address
First Line	:	3221 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1222
Country	:	US
Telephone Number	:	928-910-7010
Fax Number	:	928-910-7011

Provider Business Practice Location Address
First Line	:	3221 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1222
Country	:	US
Telephone Number	:	928-910-7010
Fax Number	:	928-910-7011

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	03/07/2023

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