Provider Demographics
NPI:1598986739
Name:KING-DAGEN, MIRIAM ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ELIZABETH
Last Name:KING-DAGEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18404 N TATUM BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1510
Mailing Address - Country:US
Mailing Address - Phone:602-992-1900
Mailing Address - Fax:602-485-7440
Practice Address - Street 1:2500 W UTOPIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4171
Practice Address - Country:US
Practice Address - Phone:623-434-6200
Practice Address - Fax:602-434-6164
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP3336363LF0000X
AZRN178591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ743768Medicaid
AZAP3336OtherAZ STATE BOARD OF NURSING