Provider Demographics
NPI:1215910658
Name:WUNG, SHU-FEN (PHD, ACNP)
Entity type:Individual
Prefix:
First Name:SHU-FEN
Middle Name:
Last Name:WUNG
Suffix:
Gender:F
Credentials:PHD, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 N CRAYCROFT RD
Mailing Address - Street 2:STE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2849
Mailing Address - Country:US
Mailing Address - Phone:520-722-2400
Mailing Address - Fax:520-323-7532
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:STE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-722-2400
Practice Address - Fax:520-323-7532
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN115766363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ892267Medicaid
AZRN115786OtherRN LICENSE
AZRN115786OtherRN LICENSE
Z132843Medicare PIN
AZ892267Medicaid