Healthcare Provider Details

I. General information

NPI: 1295445112
Provider Name (Legal Business Name): CAROLYNE W MUNGE PMHNP,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 N 7TH ST
PHOENIX AZ
85014-5005
US

IV. Provider business mailing address

3877 N 7TH ST
PHOENIX AZ
85014-5072
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax:
Mailing address:
  • Phone: 602-258-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number288317
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: