Provider Demographics
NPI:1154652170
Name:PAGANO, JOANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15838 W VALE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8759
Mailing Address - Country:US
Mailing Address - Phone:623-535-7559
Mailing Address - Fax:623-932-7500
Practice Address - Street 1:15778 W YUMA RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3358
Practice Address - Country:US
Practice Address - Phone:623-932-7500
Practice Address - Fax:623-932-7502
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP036912164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse