Healthcare Provider Details

I. General information

NPI: 1356001507
Provider Name (Legal Business Name): SUMITA GYAWALI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5859 W TALAVI BLVD STE 100
GLENDALE AZ
85306-1870
US

IV. Provider business mailing address

5859 W TALAVI BLVD STE 100
GLENDALE AZ
85306-1870
US

V. Phone/Fax

Practice location:
  • Phone: 206-303-8402
  • Fax:
Mailing address:
  • Phone: 206-303-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341615
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: