=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124682653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHA-LEE CADOGAN NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2019
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 824 N 99TH AVE
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-5324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-831-7566
-----------------------------------------------------
Fax | 480-781-4856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8612
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-0126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-370-7221
-----------------------------------------------------
Fax | 480-781-4856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 225439
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------