Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71003359A | IN |
NPI | 1174817563 |
---|---|
Provider Name | Mrs. Regina Ann Rogers |
First Address | Fort Wayne, IN 46825-1675 |
Second Address | Fort Wayne, IN 46825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 14/10/2020 |