Healthcare Provider Details

I. General information

NPI: 1427920362
Provider Name (Legal Business Name): COMFORT GMANDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10032 E SOUTHERN AVE
MESA AZ
85209-2759
US

IV. Provider business mailing address

5327 W JACKALOPE LN
LAVEEN AZ
85339-1290
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-2850
  • Fax:
Mailing address:
  • Phone: 602-422-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11250510
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: