Healthcare Provider Details

I. General information

NPI: 1457990913
Provider Name (Legal Business Name): RENEE MARIE RUNDLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E. UNIVERSITY
TEMPE AZ
85281
US

IV. Provider business mailing address

15161 W REDFIELD RD
SURPRISE AZ
85379-8023
US

V. Phone/Fax

Practice location:
  • Phone: 623-687-6680
  • Fax:
Mailing address:
  • Phone: 623-687-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTEMP236654
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11190566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: