Healthcare Provider Details

I. General information

NPI: 1518799311
Provider Name (Legal Business Name): KATRINA DAGONDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 ATLANTIC AVE APT 1
BROOKLYN NY
11201-5656
US

IV. Provider business mailing address

176 ATLANTIC AVE APT 1
BROOKLYN NY
11201-5656
US

V. Phone/Fax

Practice location:
  • Phone: 617-406-9484
  • Fax:
Mailing address:
  • Phone: 617-406-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number93909901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: