Provider Demographics
NPI:1083924666
Name:SUNDENE, NICOLE DENISE (NMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DENISE
Last Name:SUNDENE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 N SAGUARO BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4630
Mailing Address - Country:US
Mailing Address - Phone:480-837-2600
Mailing Address - Fax:480-837-2211
Practice Address - Street 1:11673 N SAGUARO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4630
Practice Address - Country:US
Practice Address - Phone:480-837-2600
Practice Address - Fax:480-837-2211
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine