Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.022340 | OH |
NPI | 1003315466 |
---|---|
Provider Name | Monalisa Ann Rodgers |
First Address | Geneva, IN 46740-1020 |
Second Address | Geneva, IN 46740-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 14/12/2021 |