Healthcare Provider Details

I. General information

NPI: 1700191426
Provider Name (Legal Business Name): DEANDRA L. DAGEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 12/29/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W FRYE RD
CHANDLER AZ
85224-6255
US

IV. Provider business mailing address

1950 W FRYE RD
CHANDLER AZ
85224-6255
US

V. Phone/Fax

Practice location:
  • Phone: 480-895-9555
  • Fax: 480-895-9494
Mailing address:
  • Phone: 480-895-9555
  • Fax: 480-895-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN128051
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: