Healthcare Provider Details

I. General information

NPI: 1154601466
Provider Name (Legal Business Name): KERRI DOWGIALLO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. HOSPITAL DRIVE
WHITERIVER AZ
85942
US

IV. Provider business mailing address

200 W. HOSPITAL DRIVE
WHITERIVER AZ
85942
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax:
Mailing address:
  • Phone: 928-338-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number70516
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: