Healthcare Provider Details

I. General information

NPI: 1235384462
Provider Name (Legal Business Name): MARCIA J GONYEA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA J NULL RN

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 W MCDOWELL RD SUITE 16
PHOENIX AZ
85035-3945
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 300
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-278-1414
  • Fax: 602-269-8410
Mailing address:
  • Phone: 602-952-3400
  • Fax: 602-952-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN055515
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: