MEDICARE: MISS KIMBERLY LYNETTE ROGERS LPN

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	164W00000X	Licensed Practical Nurse	121675	OH

General Provider Information

NPI Number	:	1992957831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY LYNETTE ROGERS LPN

Provider Business Mailing Address
First Line	:	13074 CEDAR RD.
Second Line	:
City	:	CLEVELAND HTS.
State	:	OH
Zip	:	44118
Country	:	US
Telephone Number	:	216-321-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	13074 CEDAR RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2752
Country	:	US
Telephone Number	:	216-321-9110
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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