Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1043702350 |
---|---|
Provider Name | Mrs. Katriel Marie Rogers |
First Address | Mc Donald, TN 37353-5484 |
Second Address | Mc Donald, TN 37353-5484 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 01/12/2019 |