Provider Demographics
NPI:1912258765
Name:ROGERS, MICHAEL JOHN (LPN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:651 ORCHARD STREET
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744
Mailing Address - Country:US
Mailing Address - Phone:774-992-7060
Mailing Address - Fax:774-992-7061
Practice Address - Street 1:651 ORCHARD ST
Practice Address - Street 2:SUITE 202A
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1008
Practice Address - Country:US
Practice Address - Phone:774-992-7060
Practice Address - Fax:774-992-7061
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MALN65936164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse