Healthcare Provider Details

I. General information

NPI: 1558504225
Provider Name (Legal Business Name): TRENA L DAGENHART R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRENA L HIRSCH

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

4507 HALIBUT POINT RD # B
SITKA AK
99835-9507
US

V. Phone/Fax

Practice location:
  • Phone: 907-366-2411
  • Fax:
Mailing address:
  • Phone: 907-966-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number25999
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: