Provider Demographics
NPI:1164662292
Name:DIGNOTI, JOHN SEBASTIAN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SEBASTIAN
Last Name:DIGNOTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:SEBASTIAN
Other - Last Name:DIGNOTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2422 W ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-2210
Mailing Address - Country:US
Mailing Address - Phone:602-373-7544
Mailing Address - Fax:
Practice Address - Street 1:2422 W ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-2210
Practice Address - Country:US
Practice Address - Phone:602-373-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP031508164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse