Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 92573 | OK |
NPI | 1053855684 |
---|---|
Provider Name | Alea Nicole Rogers |
First Address | Cherokee, OK 73728-2545 |
Second Address | Cherokee, OK 73728-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2016 |
Last Update Date | 16/12/2016 |