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Individual

JIMMIE SHAWN ROGERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3002 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8200
(847) 360-7377
Mailing address
3002 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8200
(847) 360-7377

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043110941
IL

Other

Enumeration date
12/03/2012
Last updated
12/03/2012
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