Healthcare Provider Details

I. General information

NPI: 1366719965
Provider Name (Legal Business Name): SONJA T GERARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E GUADALUPE RD STE 112
TEMPE AZ
85283-3269
US

IV. Provider business mailing address

PO BOX 6610
CHANDLER AZ
85246-6610
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-8552
  • Fax:
Mailing address:
  • Phone: 480-926-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4294
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: