Gdula, Mary

Gdula, Mary is an individual health care provider with primary practice located at 1 Clinic Road , Grand Canyon AZ 86023. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Gdula, Mary can be contacted via phone (928) 213-6121.

Contact Information

Primary practice address
1 Clinic Road Grand Canyon AZ 86023
Phone: (928) 213-6121
Fax: (928) 213-6136
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN116942 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP1443 Arizona

Profile Details

NPI number 1124092242
LBN Legal business name Gdula, Mary
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Oct 22nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124092242 NPPES
Arizona Other 764755 AHCCCS

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