Healthcare Provider Details

I. General information

NPI: 1992728307
Provider Name (Legal Business Name): LADONNA LYNN MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E UNIVERSITY DR
MESA AZ
85203-8169
US

IV. Provider business mailing address

PO BOX 5860
MESA AZ
85211-5860
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-6955
  • Fax: 480-898-0705
Mailing address:
  • Phone: 480-969-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 0898887
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: