Provider Demographics
NPI:1184344004
Name:RODENBAUGH, CASEY RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:RENEE
Last Name:RODENBAUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:RENEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 S DOBSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5668
Mailing Address - Country:US
Mailing Address - Phone:480-459-2555
Mailing Address - Fax:
Practice Address - Street 1:655 S DOBSON RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5668
Practice Address - Country:US
Practice Address - Phone:480-459-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN163400163WX0002X
AZ281143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk