Provider Demographics
NPI:1083642748
Name:ROGERS, CONNIE LEE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
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 6
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-0006
Mailing Address - Country:US
Mailing Address - Phone:330-277-3849
Mailing Address - Fax:
Practice Address - Street 1:17807 FIRST ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-0006
Practice Address - Country:US
Practice Address - Phone:330-277-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide