Provider Demographics
NPI:1992515720
Name:ROGERS, JANETTA
Entity type:Individual
Prefix:
First Name:JANETTA
Middle Name:
Last Name:ROGERS
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 1:611 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:WILBER
Mailing Address - State:NE
Mailing Address - Zip Code:68465-3170
Mailing Address - Country:US
Mailing Address - Phone:402-821-7170
Mailing Address - Fax:
Practice Address - Street 1:611 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WILBER
Practice Address - State:NE
Practice Address - Zip Code:68465-3170
Practice Address - Country:US
Practice Address - Phone:402-821-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEFI9967305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service