Provider Demographics
NPI:1699537696
Name:MUKUNZI, YVON MUSANGANYA (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:YVON
Middle Name:MUSANGANYA
Last Name:MUKUNZI
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 W CAMPO BELLO DR STE C120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8594
Mailing Address - Country:US
Mailing Address - Phone:602-363-0629
Mailing Address - Fax:480-247-4179
Practice Address - Street 1:7155 W CAMPO BELLO DR STE C120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8594
Practice Address - Country:US
Practice Address - Phone:602-363-0629
Practice Address - Fax:480-247-4179
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704366596363L00000X, 363LP0808X
VT101.0136887363LP0808X
AZ249028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner