Provider Demographics
NPI:1376514380
Name:GUNDEN, DEBORAH L (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:GUNDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 KARISA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6943
Mailing Address - Country:US
Mailing Address - Phone:574-534-6757
Mailing Address - Fax:574-537-0357
Practice Address - Street 1:2240 KARISA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6943
Practice Address - Country:US
Practice Address - Phone:574-534-6757
Practice Address - Fax:574-537-0357
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000520A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506110Medicaid
IN000000606423OtherANTHEM BLUE CROSS BLUE SHIELD
P50177Medicare UPIN
IN184520TTMedicare ID - Type Unspecified
IN200506110Medicaid