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General NPI Number Information
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NPI Number | 1528551595
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Entity Type | Individual
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Provider Name | PAULA D BRUNGARDT APRN
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 352 W VERDE LN
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City | TEMPE
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State | AZ
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Zip | 85284-1345
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Country | US
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Telephone | 308-224-4101
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Fax | 480-908-1567
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Provider Business Mailing Address
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Address Line | 352 W VERDE LN
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City | TEMPE
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State | AZ
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Zip | 85284-1345
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Country | US
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Telephone | 308-224-4101
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 112478
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 237934
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 237934
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License Number State | AZ
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