Provider Demographics
NPI:1861609687
Name:ARAGON, REBECCA (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ARAGON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 W HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7476
Mailing Address - Country:US
Mailing Address - Phone:623-936-9764
Mailing Address - Fax:
Practice Address - Street 1:1617 S 67TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7717
Practice Address - Country:US
Practice Address - Phone:624-707-2251
Practice Address - Fax:623-707-2254
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP006140164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse