Provider Demographics
NPI:1851918320
Name:ROGERSON, ALEXANDRA BLAISE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BLAISE
Last Name:ROGERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GATEWAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7066
Mailing Address - Country:US
Mailing Address - Phone:650-761-4056
Mailing Address - Fax:628-216-8120
Practice Address - Street 1:2417 HILLCREST MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-8086
Practice Address - Country:US
Practice Address - Phone:650-761-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001249134163W00000X
VA0024179643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse