Healthcare Provider Details

I. General information

NPI: 1538071543
Provider Name (Legal Business Name): MARY-KORINE INSUNSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 20TH ST
PARKER AZ
85344-6300
US

IV. Provider business mailing address

1112 W 20TH ST
PARKER AZ
85344-6300
US

V. Phone/Fax

Practice location:
  • Phone: 623-498-7014
  • Fax:
Mailing address:
  • Phone: 623-498-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN213218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: