Healthcare Provider Details

I. General information

NPI: 1073832721
Provider Name (Legal Business Name): ELIZABETH DVORAK MUNGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 E MOUNTAIN VIEW RD SUITE 100
SCOTTSDALE AZ
85258-5133
US

IV. Provider business mailing address

9700 N 91ST ST SUITE C-200
SCOTTSDALE AZ
85258-5054
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-5000
  • Fax: 480-425-5010
Mailing address:
  • Phone: 480-425-5000
  • Fax: 480-425-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN055765
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN055765
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: