Provider Demographics
NPI:1073353660
Name:ROGERS, KATLYN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:GALESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20765-0377
Mailing Address - Country:US
Mailing Address - Phone:443-805-4550
Mailing Address - Fax:
Practice Address - Street 1:4883 ANCHORS WAY
Practice Address - Street 2:
Practice Address - City:GALESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20765-3103
Practice Address - Country:US
Practice Address - Phone:443-805-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-311598163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant