Provider Demographics
NPI:1023095981
Name:RODGERS, BONNIE SUE (CRNP)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 BORLAND RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1524
Mailing Address - Country:US
Mailing Address - Phone:412-429-7210
Mailing Address - Fax:
Practice Address - Street 1:300 PENN LINCOLN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9772
Practice Address - Country:US
Practice Address - Phone:724-773-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005113B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily