Provider Demographics
NPI:1417745597
Name:BESONG, MBI GWENDOLINE (APRN-RNP)
Entity type:Individual
Prefix:
First Name:MBI
Middle Name:GWENDOLINE
Last Name:BESONG
Suffix:
Gender:
Credentials:APRN-RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10108 W RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4115
Mailing Address - Country:US
Mailing Address - Phone:623-329-2578
Mailing Address - Fax:
Practice Address - Street 1:6015 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1213
Practice Address - Country:US
Practice Address - Phone:623-344-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health