Individual
TANYA ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(405) 924-3591
Mailing address
14443 SW 153RD AVE, TIGARD, OR 97224-1876
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
201608367NP-PP
OR
Other
Enumeration date
02/12/2016
Last updated
10/13/2021
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