Provider Demographics
NPI:1124211719
Name:ROGAN, ELEANA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:ELEANA
Middle Name:MARIE
Last Name:ROGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELEANA
Other - Middle Name:MARIE
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2937
Mailing Address - Country:US
Mailing Address - Phone:603-580-6753
Mailing Address - Fax:603-580-6840
Practice Address - Street 1:14A TSIENNETO ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-404-6800
Practice Address - Fax:603-686-7244
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215808363L00000X
NH093522-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110015316AMedicaid
NH3133119Medicaid
MA110015316AMedicaid