Individual
DANA RENEE BALAGOT MORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8700 S KYRENE RD, TEMPE, AZ 85284-2108
(602) 599-3889
Mailing address
4344 E ELLIS ST, PHOENIX, AZ 85042-6331
(602) 599-3889
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP045914
AZ
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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