Basic Information
| Provider Information | |||||||||
| NPI: | 1093437279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIGIOVANNI | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | KYLE | ||||||||
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| Credential: | RN182320 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W 1ST ST APT 4028 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852810324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138277213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4212 N 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850165319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022631200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2022 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN182320 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.