Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704248546 | MI |
NPI | 1356822266 |
---|---|
Provider Name | Jared Aldon Rogge |
First Address | Schoolcraft, MI 49087-9140 |
Second Address | Schoolcraft, MI 49087-9140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 29/01/2021 |