=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932109261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEANNE PARKER GUNDY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 01/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 E WILCOX DR
-----------------------------------------------------
City | SIERRA VISTA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85635-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-459-4604
-----------------------------------------------------
Fax | 520-459-4603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 599 E WILCOX DR
-----------------------------------------------------
City | SIERRA VISTA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85635-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-459-4604
-----------------------------------------------------
Fax | 520-459-4603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | RN195909
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------