Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP018725 | PA |
NPI | 1073003760 |
---|---|
Provider Name | Enjoli Rogers |
First Address | Philadelphia, PA 19151-2834 |
Second Address | Exton, PA 19341-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |