Provider Demographics
NPI:1306951538
Name:ROGERS, JUDI (CRNA)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 MILL STONE RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4339
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:703-955-0720
Practice Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2464
Practice Address - Country:US
Practice Address - Phone:800-394-4445
Practice Address - Fax:706-955-0720
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164298367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001356C27Medicare PIN