Healthcare Provider Details

I. General information

NPI: 1376991547
Provider Name (Legal Business Name): REBECCA PAGNARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2016
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9328 E RAINTREE DR
SCOTTSDALE AZ
85260-2098
US

IV. Provider business mailing address

9328 E RAINTREE DR
SCOTTSDALE AZ
85260-2098
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-8463
  • Fax:
Mailing address:
  • Phone: 602-266-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN150121
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP9801
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP9801
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberAP9801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: