1538133947 NPI number — MRS. SANDRA SUE ROGERS NURSE PRACTITIONER

Table of content: MRS. SANDRA SUE ROGERS NURSE PRACTITIONER (NPI 1538133947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538133947 NPI number — MRS. SANDRA SUE ROGERS NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
SANDRA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HITCHCOCK
Provider Other First Name:
SANDRA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538133947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 COUNTY ROAD 323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCOLA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79562-2540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-572-5909
Provider Business Mailing Address Fax Number:
325-572-5909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
796 LOUISIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DYESS AFB
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-696-5432
Provider Business Practice Location Address Fax Number:
325-696-5431
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  545725 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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