Provider Demographics
NPI:1104292705
Name:RODGERS, MARTINE BURDETT (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:BURDETT
Last Name:RODGERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3033 CAMPUS DR STE W225
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2752
Mailing Address - Country:US
Mailing Address - Phone:415-504-3838
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:3033 CAMPUS DR STE W225
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2752
Practice Address - Country:US
Practice Address - Phone:415-504-3838
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016918600Medicaid
FL016918600Medicaid
FLP01756391Medicare PIN