Healthcare Provider Details

I. General information

NPI: 1316431695
Provider Name (Legal Business Name): MEAGHAN VOLK GOMEZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 100
PHOENIX AZ
85013-3421
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 100
PHOENIX AZ
85013-3421
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-1112
  • Fax: 602-264-4101
Mailing address:
  • Phone: 602-265-1112
  • Fax: 602-264-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11424
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: