Healthcare Provider Details

I. General information

NPI: 1013278142
Provider Name (Legal Business Name): SUN WRIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 E ROOSEVELT ST
PHOENIX AZ
85006-3638
US

IV. Provider business mailing address

1645 E ROOSEVELT ST
PHOENIX AZ
85006-3638
US

V. Phone/Fax

Practice location:
  • Phone: 602-506-5101
  • Fax: 602-372-0342
Mailing address:
  • Phone: 602-506-5101
  • Fax: 602-372-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: