Healthcare Provider Details

I. General information

NPI: 1821622465
Provider Name (Legal Business Name): LAURA K COOK-GONGORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 306
PHOENIX AZ
85027-4019
US

IV. Provider business mailing address

19636 N 27TH AVE STE 306
PHOENIX AZ
85027-4019
US

V. Phone/Fax

Practice location:
  • Phone: 480-246-3000
  • Fax:
Mailing address:
  • Phone: 480-773-9279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRNP236347
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRNP236347
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRNP236347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: