Individual
BETH ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1 VETERANS DR, MANTENO, IL 60950-9466
(815) 468-1027
Mailing address
701 S CHESTNUT ST, WENONA, IL 61377
(815) 853-4688
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00067912
RAILROAD MEDICARE
IL
Enumeration date
05/11/2006
Last updated
07/08/2007
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