Provider Demographics
NPI:1528153293
Name:ROGOWSKI, MARY KATHERINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:ROGOWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5715 CENTRE SQUARE DRIVE
Mailing Address - Street 2:CENTREVILLE- CHANTILLY FAMILY PRACTICE
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1916
Mailing Address - Country:US
Mailing Address - Phone:703-631-5151
Mailing Address - Fax:703-631-9754
Practice Address - Street 1:5715 CENTRE SQUARE DRIVE
Practice Address - Street 2:CENTREVILLE- CHANTILLY FAMILY PRACTICE
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1916
Practice Address - Country:US
Practice Address - Phone:703-631-5151
Practice Address - Fax:703-631-9754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024093340363LF0000X
VA0017001073363L00000X
VA0001093340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner