Provider Demographics
NPI:1992423222
Name:ROGULIC, KRISTA DL (RN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:DL
Last Name:ROGULIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:DL
Other - Last Name:ROGULIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:360 STATION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7994
Mailing Address - Country:US
Mailing Address - Phone:815-356-2382
Mailing Address - Fax:815-356-2385
Practice Address - Street 1:360 STATION DR STE 100
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7994
Practice Address - Country:US
Practice Address - Phone:815-356-2382
Practice Address - Fax:815-356-2385
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.340586163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator