Provider Demographics
NPI:1831079011
Name:RODGERS, CHARLOTTE A
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:A
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 1:1010 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-1689
Mailing Address - Country:US
Mailing Address - Phone:309-613-6482
Mailing Address - Fax:
Practice Address - Street 1:1010 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-1689
Practice Address - Country:US
Practice Address - Phone:309-613-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily