Basic Information
Provider Information
NPI: 1578722930
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EPSTEIN
FirstName: DANA
MiddleName: ROBIN
NamePrefix: DR.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1343 E CHILTON DR
Address2:  
City: TEMPE
State: AZ
PostalCode: 852835029
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 650 E INDIAN SCHOOL RD
Address2: RS/151
City: PHOENIX
State: AZ
PostalCode: 850121839
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2008
LastUpdateDate: 06/02/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X029252AZY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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