Individual provider Active NPI

Mary Clare Rogala, CNP;PA C

  • Registered Nurse
  • Wilkes Barre, PA
National Provider Identifier
1861403214
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
1975931 Issued in NY
Practice address
1111 E End Blvd
Wilkes Barre, PA 18711-0030
Phone
(570) 824-3521
Fax
(570) 819-5173
NPI assigned
Aug 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN15737L PA
Registered Nurse 163W00000X 1975931 NY Primary
Physician Assistant 363A00000X 00022321 NY
Nurse Practitioner 363L00000X RN960459 DC
Adult Health Nurse Practitioner 363LA2200X TP000299C PA

Addresses

Primary practice location

1111 E End Blvd
Wilkes Barre, PA 18711-0030

Mailing address

720 Center St
Clarks Summit, PA 18411-1962
Phone (570) 587-3468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1975931NYMDRegistered Nurse
RN15737LPAMDRegistered Nurse
00022321NYMDPhysician Assistant
RN960459DCMDNurse Practitioner
TP000299CPAMDAdult Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1861403214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 CENTER ST",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111962",
            "telephone_number": "570-587-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E END BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110030",
            "telephone_number": "570-824-3521",
            "fax_number": "570-819-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGALA",
        "first_name": "MARY",
        "middle_name": "CLARE",
        "credential": "CNP;PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN15737L",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "1975931",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "00022321",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DC",
            "license": "RN960459",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "TP000299C",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.