Healthcare Provider Details

I. General information

NPI: 1770207862
Provider Name (Legal Business Name): GEOFFREY RICHARD CUNNINGHAM FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

9723 E BALANCING ROCK RD
SCOTTSDALE AZ
85262-2320
US

V. Phone/Fax

Practice location:
  • Phone: 602-530-6900
  • Fax:
Mailing address:
  • Phone: 303-589-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number279554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: