| Organization Name: | DAGENAIS & ASSOCIATES MEDICAL CLINIC, LLC |
| NPI Number: | 1043618572 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JANE DAGENAIS (OWNER) |
| Mailing Address: | 137 East Main Pawhuska |
| State: | OK US |
| Postal Code: | 74056 |
| Phone Number: | 9182178696 |
| Fax Number: | 9182178696 |
| NPI Enumeration Date: | 12/16/2014 |
| NPI Last Update Date: | 04/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1218 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |