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General NPI Number Information
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NPI Number | 1699537696
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Entity Type | Individual
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Provider Name | YVON MUSANGANYA MUKUNZI MSN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 02/09/2025
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Provider Practice Location Address
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Address Line | 7155 W CAMPO BELLO DR STE C120
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City | GLENDALE
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State | AZ
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Zip | 85308-8594
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Country | US
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Telephone | 602-363-0629
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Fax | 480-247-4179
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Provider Business Mailing Address
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Address Line | 7155 W CAMPO BELLO DR STE C120
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City | GLENDALE
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State | AZ
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Zip | 85308-8594
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Country | US
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Telephone | 602-363-0629
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Fax | 480-247-4179
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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 | 4704366596
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0136887
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License Number State | VT
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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 | 4704366596
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 249028
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License Number State | AZ
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