Healthcare Provider Details

I. General information

NPI: 1851356257
Provider Name (Legal Business Name): ROSEMARIE GARDUNO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E BROADWAY RD STE 120
TEMPE AZ
85282
US

IV. Provider business mailing address

1232 E BROADWAY RD STE 120
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax: 480-967-3528
Mailing address:
  • Phone: 480-784-1514
  • Fax: 480-967-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN085099
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: