Healthcare Provider Details

I. General information

NPI: 1922033588
Provider Name (Legal Business Name): DEBRA D. GWERDER FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 N POWER RD STE 102-220
MESA AZ
85215-1758
US

IV. Provider business mailing address

2733 N POWER RD STE 102-220
MESA AZ
85215-1758
US

V. Phone/Fax

Practice location:
  • Phone: 480-364-5149
  • Fax: 480-900-8476
Mailing address:
  • Phone: 480-364-5149
  • Fax: 480-900-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number046515
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP0700
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: