Provider Demographics
NPI:1124123344
Name:RODGERS, MARCHETA L (ACNP-C)
Entity type:Individual
Prefix:
First Name:MARCHETA
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:MARCHETA
Other - Middle Name:L
Other - Last Name:CATES - CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 W IOWA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1723
Mailing Address - Country:US
Mailing Address - Phone:812-424-4602
Mailing Address - Fax:812-421-5147
Practice Address - Street 1:313 W IOWA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1723
Practice Address - Country:US
Practice Address - Phone:812-424-4602
Practice Address - Fax:812-421-5147
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001581A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP64585Medicare UPIN