Provider Demographics
NPI:1144318957
Name:RODGERS, DEBRA LYNN (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27646 CORTE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5924
Mailing Address - Country:US
Mailing Address - Phone:951-243-3149
Mailing Address - Fax:
Practice Address - Street 1:6896 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2843
Practice Address - Country:US
Practice Address - Phone:951-787-4885
Practice Address - Fax:951-787-4962
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily