Provider Demographics
NPI:1871969063
Name:DELGUDICO, MEGAN MICHEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHEL
Last Name:DELGUDICO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MICHEL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:1850 N CENTRAL AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4633
Mailing Address - Country:US
Mailing Address - Phone:602-262-8917
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1331 N 7TH ST STE 355
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:480-991-3005
Practice Address - Fax:602-547-6887
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 7823363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ180854Medicare PIN