Provider Demographics
NPI:1932109261
Name:GUNDY, LEANNE PARKER (NP)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:PARKER
Last Name:GUNDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2531
Mailing Address - Country:US
Mailing Address - Phone:520-459-4604
Mailing Address - Fax:520-459-4603
Practice Address - Street 1:599 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2531
Practice Address - Country:US
Practice Address - Phone:520-459-4604
Practice Address - Fax:520-459-4603
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN195909363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ185028OtherMEDICARE ID
UTU000077647Medicare PIN