Provider Demographics
NPI:1497079438
Name:CHUNG, HEATHER LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:CHUNG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4204
Mailing Address - Country:US
Mailing Address - Phone:480-222-7246
Mailing Address - Fax:480-222-7271
Practice Address - Street 1:20950 N TATUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4204
Practice Address - Country:US
Practice Address - Phone:480-222-7246
Practice Address - Fax:480-222-7271
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN14182207LP2900X
AZAP3565207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine