Healthcare Provider Details

I. General information

NPI: 1932789989
Provider Name (Legal Business Name): STEVEN GONOS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S IDAHO RD STE 140
APACHE JUNCTION AZ
85119-0006
US

IV. Provider business mailing address

3710 E YEAGER DR
GILBERT AZ
85295-1615
US

V. Phone/Fax

Practice location:
  • Phone: 480-535-3600
  • Fax:
Mailing address:
  • Phone: 602-723-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number256580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: