Individual
NICOLE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2310 CALIFORNIA RD STE A, ELKHART, IN 46514-1228
(574) 264-0791
Mailing address
2310 CALIFORNIA RD STE A, ELKHART, IN 46514-1228
(574) 264-0791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004656A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300100210
—
IN
Enumeration date
08/16/2024
Last updated
07/28/2026
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