Provider Demographics
NPI:1053077479
Name:NUNEZ, MARIA GUADALUPE (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8475 E HARTFORD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5477
Mailing Address - Country:US
Mailing Address - Phone:480-591-9345
Mailing Address - Fax:
Practice Address - Street 1:2145 W 28TH ST STE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1219
Practice Address - Country:US
Practice Address - Phone:928-328-8338
Practice Address - Fax:928-328-8339
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ266623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120218Medicaid