Healthcare Provider Details

I. General information

NPI: 1932672086
Provider Name (Legal Business Name): DONKA DYER-ABOUGOU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 E FOURWING PL
TUCSON AZ
85748-3552
US

IV. Provider business mailing address

10950 E FOURWING PL
TUCSON AZ
85748-3552
US

V. Phone/Fax

Practice location:
  • Phone: 520-362-7074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN046169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: