Provider Demographics
NPI:1366637456
Name:GUNDRY, CHARLENE A (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:GUNDRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W ESPERANZA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2667
Mailing Address - Country:US
Mailing Address - Phone:520-625-4401
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:15921 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735
Practice Address - Country:US
Practice Address - Phone:520-625-3691
Practice Address - Fax:520-822-2335
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN080667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily