Provider Demographics
NPI:1205594413
Name:DAGOBERG, ELIZABETH (DNP, AG-ACNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DAGOBERG
Suffix:
Gender:F
Credentials:DNP, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 E AMBER RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7741
Mailing Address - Country:US
Mailing Address - Phone:480-381-9575
Mailing Address - Fax:
Practice Address - Street 1:161 E RIVULON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0035
Practice Address - Country:US
Practice Address - Phone:602-739-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275445363LG0600X, 363LA2100X
390200000X
AZRN200398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse