Provider Demographics
NPI:1417787391
Name:RODGERS, MARCELLA LYNNE
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:LYNNE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MELLOR DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4008
Mailing Address - Country:US
Mailing Address - Phone:919-434-4158
Mailing Address - Fax:
Practice Address - Street 1:226 MELLOR DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4008
Practice Address - Country:US
Practice Address - Phone:919-434-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.559763163W00000X
NC183653163W00000X
OR10020124163W00000X
HI116207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse