Healthcare Provider Details

I. General information

NPI: 1578013652
Provider Name (Legal Business Name): GRESHEENE DEA KUHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 E HUNT HWY STE 105
SAN TAN VALLEY AZ
85143-5096
US

IV. Provider business mailing address

4600 S MILL AVE STE 280
TEMPE AZ
85282-6850
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-677-8283
Mailing address:
  • Phone: 480-305-2888
  • Fax: 480-305-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: