Individual
AMANDA ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD APRN MHS CPT
Contact information
Practice address
505 N MAIN ST # 1113, NAUGATUCK, CT 06770-9994
(203) 510-1234
Mailing address
505 N MAIN ST # 1113, NAUGATUCK, CT 06770-9994
(203) 510-1234
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
20-1508Y10
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157404580
DRIVERS LICENSE
CT
Enumeration date
11/11/2020
Last updated
11/11/2020
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