Basic Information
| Provider Information | |||||||||
| NPI: | 1699246314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | BRIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 FLORABUNDA LN | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080774530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562200441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 680 HEACOCK RD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190676346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154938040 | ||||||||
| FaxNumber: | 2154936704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | SP019689 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | SP019689 | 01 | PA | CRNP PEDIATRIC PRIMARY CARE LICENSE | OTHER |