Provider Demographics
NPI:1285233775
Name:ROGERS, DANIELLE LYNNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NEWBURY AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2363
Mailing Address - Country:US
Mailing Address - Phone:978-660-0343
Mailing Address - Fax:
Practice Address - Street 1:121 CHARLES ST STE 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3256
Practice Address - Country:US
Practice Address - Phone:857-452-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2320711363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse