Basic Information
| Provider Information | |||||||||
| NPI: | 1073832721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNGER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | DVORAK | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 N 91ST ST | ||||||||
| Address2: | SUITE C-200 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852585054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804255000 | ||||||||
| FaxNumber: | 4804255010 | ||||||||
| Practice Location | |||||||||
| Address1: | 9220 E MOUNTAIN VIEW RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852585133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804255000 | ||||||||
| FaxNumber: | 4804255010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2010 | ||||||||
| LastUpdateDate: | 06/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN055765 | AZ | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 164W00000X | RN055765 | AZ | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.