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General NPI Number Information
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NPI Number | 1558504225
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Entity Type | Individual
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Provider Name | TRENA L DAGENHART R.N.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 222 TONGASS DR
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City | SITKA
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State | AK
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Zip | 99835-9416
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Country | US
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Telephone | 907-366-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 4507 HALIBUT POINT RD # B
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City | SITKA
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State | AK
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Zip | 99835-9507
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Country | US
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Telephone | 907-966-3419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 25999
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License Number State | AK
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