Provider Demographics
NPI:1447578521
Name:DUGAR, TERRESSA SHONTEL (PNP)
Entity Type:Individual
Prefix:
First Name:TERRESSA
Middle Name:SHONTEL
Last Name:DUGAR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SHONTEL
Other - Middle Name:
Other - Last Name:DUGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BUILDING 2108, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8029
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4830
Practice Address - Fax:513-636-7868
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA -15667-NP363L00000X
AZRN126636/AP3660363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner