Provider Demographics
NPI:1851356257
Name:GARDUNO, ROSEMARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 E BROADWAY RD
Mailing Address - Street 2:STE 120
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-967-3528
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:STE 120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-967-3528
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN085099364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN085099OtherBOARD OF NURSING
AZAP038581534OtherBOARD OF NURSING