Provider Demographics
NPI:1215938717
Name:ROGERS, GLENDA S (RN)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26641 LAS ONDAS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3928
Mailing Address - Country:US
Mailing Address - Phone:949-364-1007
Mailing Address - Fax:949-364-0317
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 351
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-364-0317
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH128526OtherREGISTERED NURSE
CA260362OtherREGISTERED NURSE