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General NPI Number Information
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NPI Number | 1366042988
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH KLUNK CPNP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 14823 W BELL RD STE 208
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City | SURPRISE
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State | AZ
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Zip | 85374-7613
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Country | US
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Telephone | 623-225-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 21751 N 86TH LN
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City | PEORIA
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State | AZ
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Zip | 85382-2497
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Country | US
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Telephone | 928-592-2994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 271552
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN211157
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License Number State | AZ
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