Provider Demographics
NPI:1700398716
Name:GUNN, AMANDA PAIGE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:GUNN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 E MAYO BLVD APT 4412
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5633
Mailing Address - Country:US
Mailing Address - Phone:847-471-3443
Mailing Address - Fax:
Practice Address - Street 1:13771 N FOUNTAIN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3762
Practice Address - Country:US
Practice Address - Phone:888-662-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2023-07-24
Deactivation Date:2023-06-28
Deactivation Code:
Reactivation Date:2023-07-18
Provider Licenses
StateLicense IDTaxonomies
IL041.458754163WP0808X
AZ267924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health