Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP024208 | PA |
NPI | 1003581620 |
---|---|
Provider Name | Justin Rogers |
First Address | Harrisburg, PA 17101-2010 |
Second Address | Harrisburg, PA 17101-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |