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Individual

MRS. STACY MARIE ROGERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1200 N MARTIN LUTHER KING HWY, #250, LAKE CHARLES, LA 70601-2000
(337) 437-3791
(337) 437-3793
Mailing address
1200 N MARTIN LUTHER KING HWY, #250, LAKE CHARLES, LA 70601-2000
(337) 437-3791
(337) 437-3793

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200573
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1793701
LA
01
19D1094002
CLIA
LA
Enumeration date
12/29/2008
Last updated
01/13/2010
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