Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 630997 | TX |
NPI | 1023280419 |
---|---|
Provider Name | Elizabeth Stiles Rogers |
First Address | Amarillo, TX 79106-1787 |
Second Address | Amarillo, TX 79106-1791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2008 |
Last Update Date | 26/10/2021 |