Provider Demographics
NPI:1902069735
Name:ROGERS, MIRIAM PATRICIA (RN,EDD,CNS,AOCN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:PATRICIA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN,EDD,CNS,AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HUNTING HILL CIR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2917
Mailing Address - Country:US
Mailing Address - Phone:919-264-6256
Mailing Address - Fax:
Practice Address - Street 1:10010 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8494
Practice Address - Country:US
Practice Address - Phone:919-431-9201
Practice Address - Fax:919-431-9213
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96121364SX0200X
SC4038CSO364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP13895Medicare UPIN
NC2599342AMedicare PIN