Provider Demographics
NPI:1508868092
Name:GUNNUFSON, ANITA MARILYN (RNP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARILYN
Last Name:GUNNUFSON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 E WREN DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5349
Mailing Address - Country:US
Mailing Address - Phone:928-632-7562
Mailing Address - Fax:
Practice Address - Street 1:HC 76 HWY 89A JCT 151
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:602-335-2000
Practice Address - Fax:602-335-2049
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN068982363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ067224Medicaid