Individual
JAN ELISA ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
485 VALLEY RD, MOCKSVILLE, NC 27028-2074
(336) 751-8000
(336) 751-8010
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
125085
NC
363L00000X
Nurse Practitioner
Primary
5007136
NC
363LF0000X
Family Nurse Practitioner
5007136
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356741102
BCBS
NC
05
—
1356741102
—
NC
Enumeration date
08/29/2014
Last updated
10/26/2020
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