Provider Demographics
NPI:1811953961
Name:KUNTZ-SIMPSON, MARILYN M (PA-C, MHSC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:M
Last Name:KUNTZ-SIMPSON
Suffix:
Gender:F
Credentials:PA-C, MHSC
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:M
Other - Last Name:KUNTZ-SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MHSC
Mailing Address - Street 1:20401 N 73RD ST STE 255
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4147
Mailing Address - Country:US
Mailing Address - Phone:480-323-1880
Mailing Address - Fax:480-905-1136
Practice Address - Street 1:20401 N 73RD ST STE 255
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4147
Practice Address - Country:US
Practice Address - Phone:480-323-1880
Practice Address - Fax:480-905-1136
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant