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General NPI Number Information
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NPI Number | 1366112120
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Entity Type | Individual
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Provider Name | HARDY GUNSALUS CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 4605 E ELWOOD ST STE 500
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City | PHOENIX
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State | AZ
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Zip | 85040-1978
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Country | US
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Telephone | 480-256-1518
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Fax | 480-304-3446
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Provider Business Mailing Address
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Address Line | 4605 E ELWOOD ST STE 500
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City | PHOENIX
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State | AZ
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Zip | 85040-1978
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Country | US
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Telephone | 480-256-1518
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Fax | 480-304-3446
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0098706
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 268241
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License Number State | AZ
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