Provider Demographics
NPI:1073985875
Name:RUNDLE, GRACIELA BRIGE (NMD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:BRIGE
Last Name:RUNDLE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:GRACIELA
Other - Middle Name:BRIGE
Other - Last Name:RUNDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NMD
Mailing Address - Street 1:6514 S 41ST LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4946
Mailing Address - Country:US
Mailing Address - Phone:623-693-5435
Mailing Address - Fax:
Practice Address - Street 1:6514 S 41ST LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4946
Practice Address - Country:US
Practice Address - Phone:623-693-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ151514175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath