Healthcare Provider Details

I. General information

NPI: 1154207090
Provider Name (Legal Business Name): NICOLE A PFUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 E RIGGS RD STE 105
SUN LAKES AZ
85248-7646
US

IV. Provider business mailing address

36305 N GANTZEL RD STE 104
SAN TAN VALLEY AZ
85140-7326
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-6521
  • Fax: 480-420-3659
Mailing address:
  • Phone: 480-331-6521
  • Fax: 480-420-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA16474
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA16474
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: