Individual
MRS. LISA ANNE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
158 E MAIN ST, BAY SHORE, NY 11706-8302
(631) 665-5634
Mailing address
158 E MAIN ST, BAY SHORE, NY 11706-8302
(631) 665-5634
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
631165
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F308324-1
NY
Other
Enumeration date
04/25/2017
Last updated
08/05/2017
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