Active NPI
Mary Pat Degagne, PNP
- Pediatric Nurse Practitioner
- Santa Rosa, CA
National Provider Identifier
1326151374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 225
- Practice address
- 500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558 - Phone
- (707) 544-6090
- Fax
- (707) 544-2389
- NPI assigned
- Aug 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 225 | CA | Primary |
Addresses
Primary practice location
500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558
Mailing address
500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558
Phone (707) 544-6090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 366801 RN | Other | CA | RN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 225 | CA | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326151374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 DOYLE PARK DR",
"address_2": "SUITE 100",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954054558",
"telephone_number": "707-544-6090",
"fax_number": "707-544-2389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 DOYLE PARK DR",
"address_2": "SUITE 100",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954054558",
"telephone_number": "707-544-6090",
"fax_number": "707-544-2389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGAGNE",
"first_name": "MARY PAT",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "225",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "366801 RN",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.