Provider Demographics
NPI:1194500785
Name:GUNTHER, ADDISON MAE
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:MAE
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADDI
Other - Middle Name:
Other - Last Name:GUNTHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13127 W PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-8354
Mailing Address - Country:US
Mailing Address - Phone:623-262-4996
Mailing Address - Fax:
Practice Address - Street 1:13127 W PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-8354
Practice Address - Country:US
Practice Address - Phone:623-262-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse