Healthcare Provider Details

I. General information

NPI: 1417071390
Provider Name (Legal Business Name): MARLA SUE MOUNCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 E VALLEY VIEW RD
SCOTTSDALE AZ
85250-6768
US

IV. Provider business mailing address

10015 E SHANGRI LA RD
SCOTTSDALE AZ
85260-6314
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-5077
  • Fax:
Mailing address:
  • Phone: 480-484-2411
  • Fax: 480-551-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN121840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: