Provider Demographics
NPI:1447706908
Name:RODGERS, MARQUITA S (LPN)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:S
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ARTY DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5127
Mailing Address - Country:US
Mailing Address - Phone:716-235-3703
Mailing Address - Fax:
Practice Address - Street 1:69 DELAWARE AVE RM 1200
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3805
Practice Address - Country:US
Practice Address - Phone:716-852-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271005-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse