Provider Demographics
NPI:1336480243
Name:KUMPULA, ANNELI (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:ANNELI
Middle Name:
Last Name:KUMPULA
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 W BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8115
Mailing Address - Country:US
Mailing Address - Phone:623-776-5366
Mailing Address - Fax:623-252-0575
Practice Address - Street 1:42815 N 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-0900
Practice Address - Country:US
Practice Address - Phone:623-776-5366
Practice Address - Fax:623-252-0575
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4902363LF0000X
COC-APN.0003350363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000198687Medicaid