Provider Demographics
NPI:1649353780
Name:ROSDAHL, DANA R (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:ROSDAHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N DOBSON RD
Mailing Address - Street 2:STE 16
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:480-634-7833
Mailing Address - Fax:480-275-5687
Practice Address - Street 1:333 N DOBSON RD
Practice Address - Street 2:STE 16
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-634-7833
Practice Address - Fax:480-275-5687
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN057911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ718661Medicaid
AZZ65748Medicare PIN
AZ718661Medicaid
S98206Medicare UPIN