Healthcare Provider Details

I. General information

NPI: 1487347332
Provider Name (Legal Business Name): VINESSA DEGON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE STE 150
PHOENIX AZ
85007-4075
US

IV. Provider business mailing address

1201 S 7TH AVE STE 150
PHOENIX AZ
85007-4075
US

V. Phone/Fax

Practice location:
  • Phone: 602-416-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN195693
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number301765
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: