Individual
DANIELLE LEE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2920 S MCINTIRE DR STE 350, BLOOMINGTON, IN 47403-4215
(812) 332-2226
(812) 339-2934
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008374A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540381
MEDICARE PTAN
IN
05
—
300019229
—
IN
01
—
P02151167
RAILROAD PTAN
IN
Enumeration date
09/21/2018
Last updated
06/14/2023
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