Annetta Rachelle Medaugh, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN120006 Issued in AZ

Practice address

4175 S Alamo Ave
Davis Monthan Afb, AZ 85707-4402

Phone

(520) 228-2894

Fax

(520) 228-2185

NPI assigned

Sep 27, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254009600000",
    "number": "1578897310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "DAVIS MONTHAN AFB",
            "state": "AZ",
            "postal_code": "857074402",
            "telephone_number": "520-228-2894",
            "fax_number": "520-228-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "DAVIS MONTHAN AFB",
            "state": "AZ",
            "postal_code": "857074402",
            "telephone_number": "520-228-2894",
            "fax_number": "520-228-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDAUGH",
        "first_name": "ANNETTA",
        "middle_name": "RACHELLE",
        "name_prefix": "Mrs.",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-27",
        "last_updated": "2009-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN120006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Robert Land, PA
• Daniel Cooper Lee Jr., DDS
• Robin L Livingston, DMD
• Payton Lofton, DMD
• Jacob Mack, DMD
• Shane Michael Mikolajewski, PA-C
• Nicholas Miller, DDS
• Erin Moore, PA-C
• John Patrick Moran, M.D.
• Nationwide Optometry P.C.

• Registered Nurse in Davis Monthan Afb, AZ
• Providers in Davis Monthan Afb, AZ by specialty
• Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.