Healthcare Provider Details

I. General information

NPI: 1538838172
Provider Name (Legal Business Name): KEELY PUCHALSKI ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W ELLIOT RD STE 103
GILBERT AZ
85233-5168
US

IV. Provider business mailing address

1489 W ELLIOT RD STE 103
GILBERT AZ
85233-5168
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-2999
  • Fax: 480-520-4050
Mailing address:
  • Phone: 480-256-2999
  • Fax: 480-520-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number21-1951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: