Provider Demographics
NPI:1679265359
Name:ROGERS, TIANA NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:TIANA
Middle Name:NICOLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11115 W MEADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5054
Mailing Address - Country:US
Mailing Address - Phone:385-422-1895
Mailing Address - Fax:
Practice Address - Street 1:11115 W MEADOW CREEK DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5054
Practice Address - Country:US
Practice Address - Phone:385-422-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach