Provider Demographics
NPI:1538334602
Name:RODGERS, EMMA JEAN
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JEAN
Last Name:RODGERS
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 1:1929 CANAL DR WILSON
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1618
Mailing Address - Country:US
Mailing Address - Phone:252-291-4038
Mailing Address - Fax:
Practice Address - Street 1:1929 CANAL DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1618
Practice Address - Country:US
Practice Address - Phone:252-291-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC330014320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities