Basic Information
| Provider Information | |||||||||
| NPI: | 1558788992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | RENA | ||||||||
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| Credential: | AG-ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 823 | ||||||||
| Address2: | 950 SKIPPERVILLE ROAD | ||||||||
| City: | OZARK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363610823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065371657 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 601 DR MARTIN LUTHER KING JR AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057278000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 161745 | TN | N | Nursing Service Providers | Registered Nurse | 163W00000X | 1-128304 | AL | N | Nursing Service Providers | Registered Nurse | 163W00000X | 9315690 | FL | N | Nursing Service Providers | Registered Nurse | 363LA2100X | RN188422 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | CNP 02405 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 163W00000X | RN 79494 | NM | N | Nursing Service Providers | Registered Nurse |
No ID Information.