Provider Demographics
NPI:1821650201
Name:DAGNY, REBEKAH ELLEN (PEDIATRIC NURSE PRAC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELLEN
Last Name:DAGNY
Suffix:
Gender:F
Credentials:PEDIATRIC NURSE PRAC
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ELLEN
Other - Last Name:CHARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PEDIATRIC NURSE PRAC
Mailing Address - Street 1:1205 N F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-515-8690
Practice Address - Street 1:115 CALLE PORTAL SUITE 700
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2950
Practice Address - Country:US
Practice Address - Phone:520-459-3011
Practice Address - Fax:520-515-8690
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227489363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics