Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 148732 | WI |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP8704 | AZ |
NPI | 1003839176 |
---|---|
Provider Name | Mrs. Dana M. Rodriguez |
First Address | Maricopa, AZ 85138-4558 |
Second Address | Maricopa, AZ 85138-4558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 22/06/2017 |