Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R207622 | MD |
NPI | 1164812236 |
---|---|
Provider Name | Laura Rogers |
First Address | Montgomery Village, MD 20886-1138 |
Second Address | Silver Spring, MD 20910-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2015 |
Last Update Date | 28/01/2015 |