Provider Demographics
NPI:1508504606
Name:DAGNE, DAGMAWI
Entity Type:Individual
Prefix:
First Name:DAGMAWI
Middle Name:
Last Name:DAGNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 HOBBY HORSE CT APT 812
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2928
Mailing Address - Country:US
Mailing Address - Phone:512-998-4443
Mailing Address - Fax:
Practice Address - Street 1:11900 HOBBY HORSE CT APT 812
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2928
Practice Address - Country:US
Practice Address - Phone:512-998-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803958011343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)