Basic Information
| Provider Information | |||||||||
| NPI: | 1861403214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGALA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CLARE | ||||||||
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| Credential: | CNP;PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLARKS SUMMIT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184111962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705873468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
| FaxNumber: | 5708195173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163W00000X | RN15737L | PA | X | Nursing Service Providers | Registered Nurse | 163W00000X | 1975931 | NY | X | Nursing Service Providers | Registered Nurse | 363A00000X | 00022321 | NY | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | RN960459 | DC | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | TP000299C | PA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.