Provider Demographics
NPI:1902670698
Name:ROGERS, NATHAN STEPHEN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:STEPHEN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 E GROVE AVE # NA
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6021
Mailing Address - Country:US
Mailing Address - Phone:602-469-5856
Mailing Address - Fax:
Practice Address - Street 1:1652 E GROVE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6021
Practice Address - Country:US
Practice Address - Phone:602-469-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily